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| Word |
Description |
| baclofen |
baclofen (Baclospas, Balgipen, Lioresal) is a derivative of GABA, a neurotransmitter in the brain which damps down the effects of stimulant neurotransmitters. It is used as a skeletal muscle relaxant in patients who suffer from strokes, cerebral palsy, meningitis, multiple sclerosis or spinal injury.
Adverse effects include drowsiness, nausea, vomiting confusion, fatigue and excitability. Rarely, it may cause dizziness, a fall in blood pressure, euphoria, hallucinations, depression, pins and needles, slurred speech, tremors, floppy muscles, insomnia, visual disturbances, rashes, allergic reactions, itching, noises in the ears (tinnitus), difficulty passing urine and impairment of liver function.
Precautions: It should not be used in patients with peptic ulcers. Use with caution in patients with epilepsy, serious mental illness, diabetes, strokes or impaired heart, kidney or liver function. Use with caution in the elderly, in pregnancy and in breastfeeding mothers. Tests of kidney and liver function should be carried out before and at regular intervals during treatment. The drug should be stopped gradually to reduce the risk of withdrawal effects which may affect the ability to drive. Interactions: Anti-blood pressure drugs, lithium, fentanyl, morphine, tricyclic antidepressants, levodopa, carbidopa, sedatives and sleeping drugs. |
| balsalazide |
balsalazide (Colazide) is a salicylate used to treat mild to moderate ulcerative colitis (chronic diarrhoeal disorder) and to prevent its recurrence. See 20 Drugs used to Treat Diarrhoea.
Adverse effects include headache, abdominal pain, stomach and bowel upsets, gallstones. Precautions: Do not use in patients with an allergy to salicylates, severe liver or kidney damage, in pregnancy or while breastfeeding. Use with caution in patients with asthma, bleeding disorders, ulcer, mild liver or kidney damage. Any unexplained bleeding, bruising, sore throat or generally feeling unwell should be reported. |
| bambuterol |
bambuterol (bambuterol hydrochloride, Bambec) is converted into terbutaline in the body. Terbutaline is a selective beta2 stimulant used as a bronchodilator to treat asthma. See 14 Drugs used to Treat Bronchial Asthma.
Adverse effects and Precautions are similar to those listed under salbutamol. |
| barbiturate |
barbiturate drugs are derived from barbituric acid. They were previously widely used as sleeping drugs (see 1 Sleeping Drugs) and as sedatives (see 2 Drugs used to Treat Anxiety). Some are used as anti-epileptic drugs (see 15 Drugs used to Treat Epilepsy). They depress brain function and are capable of producing drug dependence (see Introduction).
Adverse effects and Precautions of barbiturates are listed under phenobarbitone.
Rapidly acting barbiturates are used intravenously as general anaesthetics. They include thiopentone sodium and methohexitone sodium. |
| barrier |
barrier preparations usually contain water-repellent substances such as dimethicone and other silicones. They are applied as creams and ointments which also contain an oily base of white, soft paraffin or lanolin. They protect the skin from irritants, pressure, urine and faeces. |
| basiliximab |
basiliximab (Simulect) is an antibody that is used with ciclosporin and corticosteroids to prevent rejection in patients who have had a kidney transplant.
Adverse effects include allergic reactions.
Precautions: Do not use in patients who are pregnant or breastfeeding. |
| bath additives |
Bath additives usually contain an oily base (e.g. liquid paraffin, soya oil). They are used to soften the skin to treat eczema, itching and other dry skin disorders. They may have other drugs added such as antiseptics. Coal tar derivatives are frequently used as bath additives in preparations used to treat chronic eczema and psoriasis. |
| becaplermin |
becaplermin (Regranex) is a growth hormone derived from human blood that is used to treat ulcers of the skin caused by nerve damage due to poorly controlled diabetes.
Adverse effects include infection, ulcers, redness of the skin and pain. Rarely blisters and swelling may occur.
Precautions: Do not use in patients with cancer at or near the ulcer site, in pregnancy or while breastfeeding. Use with caution in patients with osteomyelitis (inflammation of the marrow and hard tissue of the bone), diseases of the arteries or infected ulcers. |
| beclometasone |
beclometasone (beclomethasone) is a potent corticosteriod (see 37 Corticosteroids). It is used by inhalation to treat asthma (Aerobec, Asmabec, Beclazone, Becloforte, Becodisks, Becotide, Filair, Pulvinal Beclometasone, Qvar, in Ventide preparations) see 14 Drugs used to Treat Bronchial Asthma. It is also used to treat hayfever and perennial rhinitis (Beclo-aqua, Beconase, Care Hayfever Relief, Nasobec, Zonivent) see 17 Antihistamine Drugs and Immunosuppressants; and to treat skin disorders (e.g. eczema) (Propaderm) see 45 Drugs used to Treat Skin Disorders.
Adverse effects: see 37 Corticosteroids. By inhalation: may cause hoarseness and thrush of the mouth and throat. To the skin: see 45 Drugs used to Treat Skin Disorders. To the nose: May cause irritation, nose bleeds, taste and smell disturbances.
Precautions: Use inhalations with caution in patients with active or dormant tuberculosis of the lungs, in breastfeeding mothers and in pregnancy, use nose sprays with caution in patients with untreated infections of the nose, in pregnancy and in breastfeeding mothers. For precautions on skin applications, see 45 Drugs used to Treat Skin Disorders. |
| Beechams |
Beechams All in One contains paracetamol, guaiphenesin and phenylephrine; Beechams Cold and Flu, Beechams Flu-Plus Berry Fruits, Beechams Flu-Plus Powder, Beechams Hot Blackcurrant, Beechams Hot Lemon and Beechams Hot Lemon and Honey contain paracetamol and phenylephrine; Beechams Flu-Plus caplets contain paracetamol, caffeine and phenylephrine; Beechams Lemon tablets contain aspirin; Beechams Powders and Beechams Powders capsules contain aspirin and caffeine; Beechams Throat Plus contains benzalkonium and hexylresorcinol. |
| Begrivac |
Begrivac is an inactivated flu vaccine. |
| benzalkonium |
benzalkonium (benzalkonium chloride) is used as an antiseptic and disinfectant. It has effects like cetrimide. It is used as a preservative in eye drops and is present in some skin applications and throat lozenges. |
| benzocaine |
benzocaine (ethyl aminobenzoate) is a local anaesthetic. It is available in lozenges (in Merocaine, in Tyrozets) to relieve pain in the mouth and throat and also in local applications (AAA Spray). May rarely cause allergic reactions. Avoid prolonged use. Use with caution in pregnancy and breastfeeding mothers. |
| benzodiazepines |
benzodiazepines are discussed in 1 Sleeping Drugs and 2 Drugs used to Treat Anxiety.
Adverse effects include drowsiness, light-headedness, fatigue, loss of control over voluntary movements (ataxia), confusion, constipation, depression, double vision or blurred vision, headache, low blood pressure, loss of memory, incontinence of urine or difficulty in passing urine, jaundice due to liver damage, changes in libido (sexual drive), altered salivation, nausea, skin rashes, slurred speech, forgetfulness, tremor, vertigo, blood disorders, depression of breathing and, with injectable preparations, thrombophlebitis (inflammation of the vein) at the site of injection. Paradoxical reactions may occur, which include talkativeness, excitement, anxiety, hallucinations, aggressiveness, antisocial behaviour, spasm of muscles, rage and disturbed sleep. Adjustment of dose up or down may make symptoms worse. In a susceptible person, benzodiazepines can trigger underlying depression and the patient may become suicidal. Harmful effects of benzodiazapines may be more frequent and severe in the elderly; the smallest dose possible should be used for the shortest duration of time. Elderly people run the risk of developing incoordination of movement, drowsiness and agitation. They may wet themselves in the night or have difficulty in passing urine, and they may become confused and forgetful. Benzodiazepines cause tolerance and dependence; see 2 Drugs used to Treat Anxiety.
Precautions: Do not use in patients who have difficulty breathing or who sometimes stop breathing for a moment in their sleep (sleep apnoea syndrome), with severe liver disease, myasthenia gravis (muscle weakness due to neuromuscular abnormality), phobic or obsessional states, drug or alcohol abuse, chronic psychosis, or as sole treatment for depression or anxiety depression. They should be used with caution in patients with chest disorders, porphyria (a hereditary disorder of metabolism), impaired kidney or liver function, in the elderly, in pregnancy, labour and in breastfeeding mothers. They may impair the ability to drive a motor vehicle or operate machinery, and they increase the effects of alcohol. See risks of withdrawal, 2 Drugs used to Treat Anxiety.
Interactions: Increased sedative effects with alcohol, general anaesthetics, opiate pain-relievers, antidepressants, antipsychotics, antihistamines, lofexidine, baclofen and nabilone; erythromycin blocks metabolism of midazolam and increases its blood level; isoniazid blocks metabolism of diazepam; rifampicin increases metabolism of diazepam; fluvoxamine increases blood levels of some benzodiazepines; anti-epileptics increase metabolism and reduce the effectiveness of clonazepam; phenytoin blood levels are affected by diazepam and possible other benzodiazepines; itraconazole, ketoconazole and fluconazole increase blood levels of midazolam and cause prolonged sedative effects; blood pressure lowering effects of anti-blood pressure drugs increased by benzodiazepines; increased sedation with alpha-blockers; diltiazem and verapamil block metabolism of midazolam and increase its blood level; disulfarim blocks metabolism of benzodiazepines and increases their sedative effects; benzodiazepines occasionally antagonize effects of levodopa; cimetidine blocks metabolism of benzodiazepines and increases their blood levels; and omeprazole blocks metabolism of diazepam and increases its blood level. |
| benzoic acid |
benzoic acid has antibacterial and anti-fungal properties. It is used as a preservative in medicines, foods and cosmetics. Salts of benzoic acid are more soluble in water than benzoic acid and are used as astringents. They are added to some oral preparations as a preservative. They can become oxidized and cause discoloration. Benzoic acid is applied to the skin to treat fungal infections of the skin, usually as a compound ointment with salicylic acid. It may also be used to clean ulcers and remove dead skin from wounds (in Aserbine).
Adverse effects: It may cause allergic reactions and large doses by mouth may irritate the stomach. It may irritate the skin, eyes and mucous membranes (e.g. lining of the mouth). |
| benzoin |
benzoin (sumatra benzoin, in Frador) is from a balsam resin. It is used in inhalations to treat catarrh and in skin applications as an antiseptic and protective agent. |
| benzoin tincture compound |
benzoin tincture compound (Friar’s Balsam) contains Sumatra benzoin, storax, aloes and alcohol. Its vapours are inhaled by adding it to boiling water and breathing in the steam. It is used in this way to relieve a blocked nose caused by a cold. |
| benzophenone |
benzophenone (oxybenzone) is a sunscreen agent. Rarely, it may cause contact dermatitis and make the skin sensitive. |
| benzoyl peroxide |
benzoyl peroxide (in Acnecide, in Benzamycin, in Brevoxyl, Panoxyl, in Quinoderm, in Quinoped) is an antiseptic (45 Drugs used to Treat Skin Disorders) and is also used for removing dead skin (45 Drugs used to Treat Skin Disorders). It is mainly used in skin applications to treat acne.
Adverse effects include skin irritation and peeling. Occasionally it may cause contact dermatitis.
Precautions: Avoid contact with eyes and lining of nose and mouth. May bleach fabrics. Do not use to treat acne rosacea. |
| benzydamine |
benzydamine (benzydamine hydrochloride) is an anti-inflammatory drug. It is present in Difflam Oral Rinse solution and Difflam Spray to treat a sore mouth and throat. It may cause numbness of the mouth. It is also present in Difflam cream used to treat muscle and joint pains. |
| benzyl alcohol |
benzyl alcohol is used as an antiseptic, and as a weak local anaesthetic, in various skin applications. |
| benzyl benzoate |
benzyl benzoate (Ascabiol) is used to treat scabies (see p. 230) Adverse effects: It may irritate the skin and occasionally cause skin rashes. It can produce a burning sensation when applied to the genitals or areas of skin that have scratch marks. Precautions: Do not use in children. Avoid contact with eyes and mucous membrances (e.g. lining of the nose, mouth, vagina). Do not use on broken or infected skin. Use with utmost caution in pregnancy and breastfeeding mothers. |
| beractant |
beractant (Survanta) is used to treat respiratory distress syndrome (hyaline membrane disease) in premature babies. Adverse effects: Bleeding into the lungs. Precautions: Continuous monitoring required to avoid too much oxygen entering the bloodstream. |
| bergamot oil |
bergamot oil is obtained from the fresh peel of fruit of Citrus bergamia (Rutaceae). It is used in perfumes and especially in hair preparations. It is also used in suntan applications, see p. 209. There is doubt that concentrations below 1% have any tanning effect and there is evidence that psoralens produce skin cancer in mice. |
| beta-blockers |
beta-blockers are discussed in Chapter 22. Adverse effects include slowing of the heart rate, fall in blood pressure, heart block, numbness and pins and needles in the hands and feet, coldness of the fingers and toes, mental depression, tiredness on exertion, insomnia, nightmares, drowsiness, confusion, weariness, fatigue, visual disturbances and hallucinations. Beta-blockers may occasionally produce a reversible depression associated with disorientation in time and place, short-term memory loss, clouded thinking and emotional changes. They may cause nausea, vomiting, stomach upsets, bowel changes, allergic reactions, wheezing; and, very rarely, blood disorders, loss of hair, a psoriasis-like skin rash and dry eyes. Precautions: Beta-blockers should not be used in patients with untreated heart failure, serious heart block, serious disorders of the circulation or untreated phaeochromocytoma (tumour of the sympathetic nervous system). They should be used with caution in late pregnancy and in breastfeeding mothers, and they should be withdrawn gradually in patients with angina. Note: Beta-blockers that are most soluble in water are less likely to enter the brain and cause disturbed sleep and nightmares etc. than the ones that are soluble in fat (lipid soluble). They include atenolol, celiprolol, nadolol and sotalol. However, because they are water soluble they are excreted by the kidneys and they may accumulate in the blood of patients whose kidney function is impaired, lower doses should therefore be given in such patients. Some beta-blockers may be able to stimulate as well as block beta-receptors (e.g. oxprenolol, pindolol and acebutolol), they therefore cause less slowing of the heart and coldness of the fingers and toes. However, remember that all beta-blockers slow the heart rate and may precipitate heart failure in those patients prone to develop heart failure. Sotalol may cause life-threatening disorders of heart rhythm. Beta-blockers affect blood sugar control and must be used with caution in diabetics. They may also mask some of the early symptoms of hypoglycaemia (see p. 195). Selective blockers should be used in diabetics but avoided if patient has frequent attacks of hypoglycaemia. Non-selective beta-blockers should definitely not be used in patients with asthma or obstructive airways disease and selective ones should preferably not be used. Beta-blockers should be used with caution in patients with heart failure controlled by digoxin and diuretics, impaired kidney or liver function, thyrotoxic crisis and general anaesthesia (withdraw before elective surgery). Interactions: verapamil, Class I anti-arrhythmic drugs, anti-diabetic drugs, general anaesthetics, reserpine, anti-blood pressure drugs, ergot drugs, cimetidine, sedatives, sleeping drugs, sympathomimetics, indomethacin. Note: Sotalol should no longer be used to treat angina, raised blood pressure or over-active thyroid. It must only be used to treat certain disorders of heart rhythm. To change over from sotalol to another drug the dose of sotalol should be gradually reduced over 1–2 weeks, the patient carefully monitored (particularly those with coronary heart disease), and at the same time replacement treatment should be started. |
| beta-lactam |
beta-lactam antibiotics have a similar basic chemical structure – a lactam ring. They include the penicillins, cephalosporins and cephalomycins. See Chapter 46. |
| betahistine |
betahistine (betahistine dihydrochoride, Serc) is used to treat vertigo, noises in the ears (tinnitus) and hearing loss associated with Ménière’s disease (for symptoms see p.79). It produces effects similar to histamine. Adverse effects include flushing, tingling, chilliness, nausea, vomiting, diarrhoea, headache, rashes, itching, rapid beating of the heart, and shivering. Precautions: It should be given with caution to patients with asthma or peptic ulcer. It should not be given to children and should not be given with antihistamines. Use with caution in pregnancy and breastfeeding mothers. |
| betaine hydrochloride |
betaine hydrochloride when dissolved in water forms hydrochloric acid. It is used to treat patients unable to produce hydrochloric acid in their stomachs. It is present in Kloref and Kloref-S used as potassium supplements. |
| betalactamases |
betalactamases are enzymes produced by certain bacteria that disrupt the chemical structure of beta-lactam antibiotics (the beta-lactam ring) thus making the antibiotics inactive, see p. 234. |
| bezafibrate |
bezafibrate (Bezagen, Bezalip, Bezalip-Mono, Zimbacol) is a fibrate drug used to reduce high blood cholesterol and fat levels (see Chapter 26). Adverse effects: Stomach and bowel upsets, itching, nettle-rash, impotence, headache, dizziness, vertigo, fatigue, hair loss and muscle damage, producing weakness and pain. Precautions: It should not be used in patients with severe liver or kidney impairment, gall-bladder disease, in pregnancy or in breastfeeding mothers. The risk of muscle damage is increased in patients with impaired kidney function and possibly underworking of the thyroid gland (see fibrates for warnings on muscle damage). Use of ciclosporin or a statin drug at the same time may increase the risks. Interactions: Anticoagulants, anti-diabetic drugs, MAOIs. |
| bicalutamide |
bicalutamide (Casodex) is an anti-androgen drug (see p. 251) used to treat cancer of the prostate gland. Adverse effects include hot flushes, weakness, itching, tenderness and swelling of the breasts and sleepiness. Rarely it may cause jaundice, liver damage, blood disorders and disorders of the heart (e.g. angina, heart failure, disorders of rhythm), stomach and bowel upsets, insomnia, dizziness, loss of appetite, dry mouth, decreased libido, impotence, sweating, rashes, breathlessness, changes in weight, fluid retention (causing swelling of the ankles), chest and abdominal pains and raised blood sugar level. Adverse effects are more likely in the elderly. Precautions: Use with caution in patients with impaired liver function. Liver function tests at start and during treatment should be considered. Interactions: Cimetidine, ketoconazole, oral anticoagulants. |
| biguanides |
biguanides are a group of drugs used to treat diabetes. See Chapter 42. The only available drug in this group is metformin. |
| bile acid sequestrants |
bile acid sequestrants, see Chapter 26. |
| BiNovum |
BiNovum is a biphasic oral contraceptive. See p. 190. |
| biphosphonates |
biphosphonates (bisphosphonates) are used to treat bone disorders. Disodium etidronate is used to treat Paget’s disease of bone. It slows down the increased rate of bone turnover that occurs in this disease. Sodium pamidronate and sodium clodronate are used to treat raised blood calcium levels in patients suffering from secondary bone cancer. Disodium etidronate is available with calcium carbonate (Didronel PMO tablets) to treat osteoporosis of the spine. |
| bisacodyl |
bisacodyl (Dulcolax) is a stimulant laxative. See Chapter 21. It may cause abdominal cramps and suppositories may produce local rectal irritation. |
| bismuth salts |
bismuth salts by injection were once widely used to treat syphilis. Soluble bismuth salts are harmful because they can be absorbed into the body and they should not be used. Insoluble salts are included in some antacid mixtures and as protectives in some skin preparations, as an astringent in haemorrhoidal preparations, in suppositories and in diarrhoea mixture. Bismuth salts by mouth have occasionally caused brain damage and bone and joint disorders after prolonged use as antacids. They can make the faeces black. |
| bleomycin |
bleomycin (Bleo-Kyowa) is used as an anti-cancer drug (see Chapter 51). It interferes with DNA synthesis in cancer cells inhibiting growth and cell division. Adverse effects include fever, anorexia, tiredness, nausea, and pain and inflammation at the injection site. Occasionally it may produce delayed effects on the lungs (interstitial pneumonia and fibrosis). Previous radiotherapy to the chest is an aggravating factor. The majority of patients may develop hard (indurated) red, tender swellings on their finger tips, ridging of the nails, lesions of the skin and mucous membranes, blisters (bullae) over pressure points and loss of hair. These usually disappear once the drug is stopped. Precautions: It should not be used in pregnant or breastfeeding women nor in patients with chest infections. Patients on treatment should have a chest X-ray weekly. The dose should be reduced in patients with impaired kidney function. |
| Bocasan |
Bocasan antiseptic produces similar effects to hydrogen peroxide. It contains sodium perborate monohydrate and sodium hydrogen tartrate. It is used as a mouth rinse to treat gingivitis and stomatitis. Do not use in patients with impaired kidney function. |
| borotanic complex |
borotanic complex is a constituent of Phytex paint, which is used to treat fungus infections of the skin and nails. The borax part of the complex has antibacterial and antifungal properties and the tannic acid part acts as an astringent. |
| botulinum toxin |
botulinum toxin (botulinum A toxin-haemagglutinin complex, Botox, Dysport, NeuroBloc) is used to treat blepharospasm (spasm of the eyelids) and one-sided facial spasm. It is given by injection into the muscles of the upper and lower eyelids and upper facial area. Adverse effects include irritation and watering of the eye, drooping of the upper eyelid, double vision and other disturbances of vision, bruising and swelling of eyelids and paralysis of muscles around the eye. Precautions: Do not use in pregnancy or in breastfeeding mothers or in disorders such as myasthenis gravis (muscle weakness due to neuromuscular abnormality). It is also used to treat spasmodic torticollis (spasms in the neck which restrict movement). |
| bowel cleaning solutions |
bowel cleaning solutions are used before surgery, endoscopy and radiological examinations of the bowel to ensure that it is completely empty of solid contents. Adverse effects include nausea, bloating, abdominal cramps, vomiting, irritation of the anus, nettle-rash and allergic reactions. Precautions: Do not use in patients with an obstruction of the stomach or intestine, perforated bowel, distension or inflammation of the bowel or if weight is less than 20 kg. Use with caution in pregnancy, in patients with ulcerative colitis (chronic diarrhoeal disorder), diabetes, oesphageal reflux, impaired gag reflex and in patients who are unconscious or semiconscious. Medicines taken by mouth within one hour of taking a bowel-cleansing solution may not be absorbed and may not therefore be effective. Preparations include Klean-Prep. |
| Brasivol |
Brasivol contains aluminium oxide in large particles and is used as an abrasive together with a cleansing base to treat acne. |
| bretylium |
bretylium (bretylium tosylate) is used to treat disorders of heart rhythm (see Chapter 24). Adverse effects: These include fall in blood pressure and nausea, and initial worsening of the disorder. Damage to tissue at site of injection may occur. Precautions: Do not use in patients with phaeochromocytoma (tumour of the sympathetic nervous system). Use with caution to treat disorders of heart rhythm caused by digoxin and do not give noradrenaline(norepinephrine) or other sympathomimetic drugs. |
| Brevinor |
Brevinor is a combined oral contraceptive. See p. 189. |
| brimonidine |
brimonidine (Alphagan) eye drops are used where β-blockers are ineffective or unsuitable, or in addition to β-blockers, in the treatment of open-angle glaucoma or high blood pressure in the eye. See Chapter 13. Adverse effects include swelling in the eye and distension of blood vessels in the eye (ocular hyperaemia), stinging, itching, allergic reactions, dry mouth, headache, fatigue and drowsiness. Precautions: Use with caution in patients with severe heart disease, depression, insufficient blood supply to the brain or heart, Raynaud's syndrome (for symptoms see p.118), low blood pressure on standing, blood clots, kidney or liver damage, in pregnancy or while breastfeeding. Do not wear soft contact lenses. |
| brinzolamide |
brinzolamide (Azopt) eye drops are used where β-blockers are ineffective or unsuitable, or in addition to β-blockers, in the treatment open-angle glaucoma or high blood pressure in the eye. See Chapter 13. Adverse effects include disturbed vision, pain in the eye, distension of blood vessels in the eye (ocular hyperaemia), unpleasant taste in the mouth, headache. Precautions: Do not use in patients with liver or severe kidney damage, disorders of blood chemistry, history of allergy to to sulphonomides or while breastfeeding. Use with caution in patients with pseudoexfoliative, pigmentary or narrow angle glaucoma, diabetes, eye disorders, those who wear contact lenses or in pregnancy. |
| Brolene |
Brolene eye drops and ointment contain the antiseptic dibromopropamidine isethionate. The eye drops also contain benzalkonium as a preservative. Not suitable for people wearing contact lenses. Of little value in treating infections of the eye except for acanthamoeba keratitis (neomycin may be used as additional treatment). |
| bromocriptine |
bromocriptine (bromocriptine mesylate, Parlodel) stimulates dopaminergic receptors. It is used in the treatment of parkinsonism, (see Chapter 16). It stops production of the milk-producing hormone proclatin, and it is used to prevent lactation after childbirth. It blocks the release of growth hormone by the pituitary gland and may be used to treat acromegaly due to overworking of the pituitary gland. It is also used to treat certain types of infertility in women, cyclical benign breast disease and severe mastalgia (painful breasts). Adverse effects include nausea, vomiting, dizziness, fall in blood pressure on standing up after sitting or lying down (may produce dizziness and light-headedness), dryness of the mouth, leg cramps, headaches, nasal congestion, constipation, and sedation. Rarely, high doses may causes hallucinations, confusion, involuntary movements (dyskinesia), coldness of the fingers and toes and a scarring disorder in the abdomen (retroperitoneal fibrosis) – stop immediately if this occurs. Precautions: Use with caution in patients with a history of psychotic illness and in patients with severe heart disease. It stimulates ovulation, therefore regular gynaecological examinations should be carried out and mechanical forms of contraception should be used if patient wishes to avoid conception. There is a risk of peptic ulcers in patients being treated for acromegaly. Do not use in patients with toxaemia of pregnancy, in women with raised blood pressure following childbirth or in patients allergic to it or to ergot drugs. Interactions: Alcohol, erythromycin, metoclopramide, antiblood pressure drugs. |
| bronchodilators |
bronchodilators are used to treat asthma. See Chapter 14. |
| budesonide |
budesonide is a potent corticosteriod used in a nasal spray to treat hayfever (seasonal rhinitis and perennial allergic rhinitis), vasomotor rhinitis and nasal polyps (Rhinocort Aqua) see p. 74; by inhalation to treat asthma (Pulmicort, Symbicort) see Chapter 14; in ointments and creams to treat skin disorders such as eczema and psoriasis (Preferid) see p. 211; and used orally in chronic diarrhoea (Budenofalk, Entocort). Adverse effects: When applied up the nose it may cause sneezing, stinging, dryness, slight nose bleeds and rarely raised pressure in the eyes, and by inhalation from an aerosol it may cause hoarseness, thrush of the mouth and throat, rarely skin rashes and paradoxical wheezing. Inhalations should not be used in patients with active tuberculosis. Nasal sprays and inhalations should be used with caution in pregnancy and in patients with viral or fungal infections. For general adverse effects and Precautions see Chapter 37 on corticosteriods; for adverse effects on the skin, see corticosteroid skin applications p. 211. |
| bumetanide |
bumetanide (Burinex, in Burinex A, in Burinex K) is a loop diuretic (see Chapter 29). Adverse effects and Precautions are similar to those listed under frusemide. Bumetanide may also cause rashes, muscle pains and thrombocytopenia. |
| bupivacaine |
bupivacaine (bupivacaine hydrochloride, in Marcain, in Marcain with adrenaline) is a local anaesthetic with effects and uses similar to lidocaine(lignocaine), but it works for a longer duration. Overdose may cause a fall in blood pressure, muscle twitching, depression of respiration and convulsions. Its use in childbirth may cause the baby’s heart to slow down. It should be used with caution in patients with liver or heart disorders, or who are elderly and/or debilitated. |
| buserelin |
buserelin is a gonadotrophin-releasing hormone analogue which is used in Superfact nasal spray to treat cancer of the prostate dependent on male sex hormones for growth. It initially stimulates the pituitary to produce luteinising hormone (LH), but the end result is that it prevents the release of LH causing a reduction in testosterone production by the testes. Adverse effects include hot flushes, irritation of the nose when nasal spray is used, loss of libido, depression, headache, dizziness, nausea, vomiting, diarrhoea, nettle-rash, and rarely swelling of the breasts. Precautions: Do not use if testicles have been removed, or in tumours which are not sensitive to male hormones. Interactions: Nasal decongestants. Buserelin is also used in Supercur nasal spray to treat endometriosis (it initially stimulates and then blocks the production of hormones by the ovaries and stops the periods). It is also used as part of infertility treatment – it desensitizes the pituitary gland prior to stimulating ovulation with gonadotrophins. Adverse effects include hot flushes, dry vagina, loss of libido, emotional upsets, breast tenderness and changes in size, headache, migraine, nausea, depression, abdominal pain, fatigue, weight changes, nervousness, dizziness, drowsiness, back pain, muscle pain, acne, nettle-rash, itching, constipation, vomiting, sleep disturbances, blurred vision, growth of body hair, pins and needles in the hands and feet, ovarian cysts and irritation of the nose. Precautions: Do not use in pregnancy and use a mechanical means of contraception if sexually active. Do not use in breastfeeding mothers, in women with undiagnosed vaginal bleeding or who are suffering from hormone dependent cancer. Use with utmost caution in patients at risk of developing osteoporosis and in patients who are depressed. |
| buspirone |
buspirone (Buspar) is an anti-anxiety drug (see Chapter 2) not related to the benzodiazepines. Adverse effects: Dizziness, headache, nervousness, light-headedness, excitement and nausea. Rarely, rapid beating of the heart, chest pain, drowsiness, confusion, dry mouth, fatigue and sweating. Precautions: Do not use in patients with epilepsy or who suffer from severe kidney or liver impairment. Do not use in pregnancy or when breast feeding. Use with caution in patients with impaired kidney or liver function. In order to avoid withdrawal symptoms, reduce benzodiazepines slowly over several weeks before starting a patient on buspirone. Interactions: MAOIs, alcohol may impair driving skills. |
| busulfan |
busulfan (Myleran) is an anti-cancer drug. See Chapter 51. Adverse effects: It may cause blood disorders producing haemorrahages and bone-marrow damage (this may be irreversible and come on several months after treatment is stopped). Loss of periods (amenorrhoea) may start up to six months after the drug is stopped. It may cause deep pigmentation of the skin and scarring of the lungs. Precautions: It should not be used in pregnancy or by breastfeeding mothers. Frequent blood counts should be carried out during and after treatment. |
| butoxyethyl nicotinate |
butoxyethyl nicotinate is used for removing dead skin (a keratolytic), see p. 217. It is present in Actinac lotion, used to treat acne. |
| butyrophenones |
butyrophenones are a group of antipsychotic drugs. See Chapter 3. The group includes benperidol, droperidol and haloperidol. They are likely to produce more pronounced movement disorders than other antipsychotics. Benperidol is used to treat deviant antisocial sexual behaviour. As well as being used as antipsychotics, droperidol and haloperidol are also used to treat nausea and vomiting produced by anti-cancer drugs. See Chapter 18. Haloperidol is also used to treat motor tics. |
| cabergoline |
cabergoline (Cabaser, Dostinex) is a dopamine-receptor stimulant used to stop milk production soon after childbirth and to suppress milk production in breastfeeding mothers. It is also used to treat disorders of the pituitary gland that cause over-production of prolactin (the milk-producing hormone) resulting in a raised level of prolactin in the blood (prolactinaemia), milk production (galactorrhoea) and menstrual disorders.
Adverse effects include headache, vertigo, nausea, dizziness, breast pain, stomach and bowel upsets, weakness, fatigue, depression, pins and needles, hot flushes. Rarely it may cause palpitations, nose bleeds, and disturbed vision (hemianopia).
Precautions: Do not use in children under 16 years of age. Do not use in pregnancy and avoid the risk of getting pregnant whilst on treatment and for one month after treatment has stopped. Use non-hormonal contraception. Do not use in patients with severe impairment of liver function, after childbirth or in mothers with a history of depression following childbirth. Use with caution in patients with kidney, liver or heart disease, Raynaud’s syndrome, stomach or bowel ulceration or bleeding, raised blood pressure or serious mental disorders. Check pituitary function before treatment and monitor blood pressure and blood prolactin levels. Stop at least one month before trying to conceive.
Interactions: Antipsychotic drugs, ergot drugs, dopamine-blockers, macrolide antibiotics and anti-blood pressure drugs. |
| Cacit D3 |
Cacit D3 is a calcium and vitamin D3 (colecalciferol) supplement see 36 Vitamins. It is used to treat calcium/vitamin D deficiency in elderly people, as supplementary treatment in patients suffering from osteoporosis, vitamin D dependent osteomalacia (adult rickets) and in pregnancy.
Adverse effects include constipation and wind.
Precautions: Do not use in patients with overactive prathyroid glands, excess of calcium in the urine, severe kidney failure or decalcifying tumours (tumours that decrease calcium in the bones and cause a rise in blood calcium levels). Use with caution in patients with impaired kidney function or a history of kidney stones. |
| cade oil |
cade oil (juniper tar) is used in skin applications (e.g. Gelcotar, Polytar) to treat eczema and psoriasis, and in medicated soaps. |
| cadexomer iodine |
cadexomer iodine is a carboxymethyl ether containing iodine. It is present in Iodosorb as a powder of micro-beads containing iodine. The micro-beads absorb fluid to form a gel which releases the iodine. It is also used as a paste (Iodoflex). It is used to treat pressure sores and varicose leg ulcers.
Precautions: Do not use in pregnancy or breastfeeding mothers or in patients with overworking of their thyroid gland and use with caution in other thyroid disorders.
Interactions: Lithium, sulphonylureas (oral anti-diabetic drugs). |
| caffeine |
caffeine has a stimulating effect upon the central nervous system and a weak diuretic effect. It is present in some over-the-counter pain-relievers, tonics and pick-me-ups.
Adverse effects and Precautions see 5 Stimulant Drugs - Tea, Coffee and Cola. |
| Caladryl |
Caladryl cream and lotion contain calamine, diphenhydramine (an antihistamine) and camphor. They are used to treat irritation of the skin, sunburn, insect bites and stings. See warning on using skin preparations containing an antihistamine see 45 Drugs used to Treat Skin Disorders.
Do not use on broken skin, lining of the mouth, nose, vagina etc. or in chicken-pox, measles or on weeping skin rashes. |
| calamine |
calamine is a zinc salt (zinc carbonate) coloured with an iron salt (ferric oxide). It is a mild astringent and is used in various skin applications. |
| calciferol |
calciferol (ergocalciferol) has the same effects and uses as vitamin D. See 36 Vitamins. Deficiency of vitamin D causes rickets in children and osteomalacia (bone softening) in adults.
Adverse effects: Excessive daily doses may produce loss of appetite, nausea, vomiting, diarrhoea, loss of weight, headache, dizziness and thirst. The amount of calcium in the urine is raised and the patient may develop kidney stones and calcification of arteries. |
| calcipotriol |
calcipotriol (Dovonex) is synthetic vitamin D. It is used as a skin cream or scalp lotion to treat mild to moderate psoriasis see 45 Drugs used to Treat Skin Disorders. It stops the over-growth of cells in the surface (epidermis) of the skin that occurs in psoriasis and helps to restore a normal turnover of the surface cells. It has less effect on calcium metabolism in the body than other synthetic vitamin D preparations (e.g. calcitriol) and therefore the risks of a raised blood calcium, calcium in the urine and bone softening are reduced.
Adverse effects include transient irritation and, rarely, dermatitis of the face or around the mouth. It may also cause itching, make the psoriasis worse, sensitize the skin to sunlight and cause a rise in blood calcium levels.
Precautions: It should not be used in patients with disorders of calcium metabolism. It should not be applied to the face, and the hands should be washed after application. It should be used with caution in pregnancy and in breastfeeding mothers. It is not recommended for children. |
| calcitriol |
calcitriol (Calcijex, Rocaltrol) is a vitamin D derivative that is used to treat bone disease caused by kidney failure. It is also used to treat post-menopausal osteoporosis.
Adverse effects: Increased level of calcium in the blood and in the urine.
Precautions: Do not use in patients with raised blood calcium levels. Do not use other vitamin D preparations. Monitor blood calcium levels and use with caution in pregnancy. |
| calcium acetate |
calcium acetate is used as a source of calcium in solutions used for dialysing blood. The powder may be used in skin applications. |
| calcium alginate |
calcium alginate is a calcium salt of alginic acid. It is used in special dressings as an absorbable material to stop bleeding from wounds. Alginate dressings may be removed by applying 3% sodium citrate solution for a few minutes and washing out with sterile water. |
| calcium carbonate |
calcium carbonate (chalk) is an antacid (in Gaviscon, in Peptac) (see 19 Drugs used to Treat Indigestion and Peptic Ulcers). It may cause constipation and belching. Avoid prolonged or excessive dosage along with an increased intake of milk or cream. This may cause the milk-alkali syndrome: loss of appetite, nausea, vomiting, headache, weakness, abdominal pains, constipation and thirst associated with a high blood calcium level and changes in the acidity of the blood. It is also used to treat calcium deficiency and osteoporosis (Adcal, in Adcal D3, Cacit, in Cacit D3, in Calceos, in Calcicard D3 Forte, in Calcichew, Calcidrink, Calcium 500, in Sandocal, in Titralac). However, calcium supplements should only be taken where dietary calcium intake is lacking. The dietary requirement varies with age and can be greater in children, pregnancy, breastfeeding mothers and the elderly. In the treatment of osteoporosis, a calcium intake which is double the normal recommended amount helps to reduce the rate of bone loss. |
| calcium channel blockers |
calcium channel blockers (calcium antagonists) see p. 100. They are used to treat angina (Chapter 22), raised blood pressure (Chapter 25), prevent migraine (Chapter 34) and to treat disorders of heart rhythm (Chapter 24). |
| calcium glubionate |
calcium glubionate (in Calcium Sandoz) is used as a source of calcium to treat and prevent calcium deficiency disorders. |
| calcium gluconate |
calcium gluconate is used as a source of calcium to treat and prevent calcium deficiency disorders. |
| calcium lactate |
calcium lactate is used as a source of calcium to treat and prevent calcium deficiency disorders. |
| calcium lactobionate |
calcium lactobionate (in Calcium Sandoz) is used as a source of calcium to treat and prevent calcium deficiency disorders. |
| calcium levofolinate |
calcium levofolinate (Isovorin) is used to enhance the effect of the anti-cancer drug 5-fluorouacil (5-FU) in cancer of the bowel. See Chapter 51. Adverse effects include allergic reactions, fever. Precautions: Do not use in pregnancy or while breastfeeding. The simultaneous administration of methotrexate should be avoided. |
| calcium salts |
calcium salts. Various salts of calcium are used to supplement the diet, as antacids, in skin preparations, to treat calcium deficiency and osteoporosis. Calcium supplements to the diet are needed if dietary intake of calcium is inadequate. Requirements vary according to age; growing children need an adequate amount of calcium in their diet and so do pregnant women, breastfeeding mothers and post-menopausal women. Children on special diets (e.g. milk-free diets) will need calcium supplements and so will patients with rickets and osteomalacia in the early stages of their treatent with vitamin D. Adverse effects: Calcium salts by mouth can cause irritation of the stomach and bowel and constipation and wind. Precautions: Use with caution in patients with obstructive bowel disease, ulceration of the bowel, and kidney stones. Do not use in patients with a raised blood calcium or a raised blood uric acid level. Interactions: Tetracyclines. |
| Calcium-Sandoz |
Calcium-Sandoz syrup is used as a source of calcium to treat and prevent calcium deficiency disorders. |
| Calmurid |
Calmurid skin preparations contain urea (a skin softener) and lactic acid (a keratolytic, see p. 217). They are used to treat chronic dry skin. |
| Calmurid HC |
Calmurid HC cream contains Calmurid with hydrocortisone (a corticosteroid) added. Adverse effects and Precautions see corticosteroid skin applications p. 211. |
| Calsalettes |
Calsalettes is a laxative containing aloin. |
| camphor |
camphor is an aromatic substance used in rheumatic liniments. It is also used to relieve itching and muscle aches. Note that camphorated oil has been withdrawn because of its toxicity. Camphor has also been used in cough medicines and to treat gripe. Camphor-related compounds (monoterpines) are occasionally used to dissolve gallstones and kidney stones. Precautions: It is dangerous to place a camphor preparation up the nostrils of an infant to relieve snuffles. Even a small quantity applied in this way may cause the infant to collapse. |
| candesartan |
candesartan (Amias) is an angiotensin-II receptor blocker used to treat high blood pressure. See Chapter 25. Adverse effects include upper respiratory tract infection, back pain. Precautions: Do not use in patients with severe liver damage, in pregnancy or while breastfeeding. Use with utmost caution in patients with obstruction to the flow of blood from the heart into the main artery (aortic stenosis), through the mitral valve (mitral stenosis) or into the main artery to a kidney (renal artery stenosis), or in patients suffering from obstructive hypertropic cardiomyopathy (enlargement of the muscles of the heart). |
| Canesten HC |
Canesten HC cream contains hydrocortisone (a corticosteroid) and clotrimazole (an antifungal drug). Adverse effects and Precautions: see corticosteroid skin applications p. 211 and υ clotrimazole. It may produce mild burning and irritation and allergic reaction. |
| Capasal |
Capasal shampoo contains salicylic acid, coconut oil and distilled coal tar. It is used to treat dry scaly scalp conditions, for example, seborrhoeic dermatitis, psoriasis and cradle cap. Contact with the eyes should be avoided and if it irritates the scalp treatment should be stopped. |
| capecitabine |
capecitabine (Xeloda) is used to treat colorectal cancer. See Chapter 51. Adverse effects include dizziness, fatigue, stomach and bowel upsets, hair loss, skin or nail damage, fever, weakness, limb pain, headache, nerve damage, fluid retention, disorders of the blood, weight loss, dehydration, difficulty breathing, watery eyes, appetite loss and nose bleeds. Precautions: Do not use in patients with severe kidney or liver damage, an allergy to fluoropyramidines or fluorouracil, certain enzyme deficiencies, blood disorders, in pregnancy or while breastfeeding. Use with caution in patients with a history of heart disease, with calcium imbalance in the blood, moderate liver or kidney damage, diabetes, diarrhoea, abdominal pain, nausea, inflammation of soft tissues in the mouth, or in the elderly. |
| capreomycin |
capreomycin (Capastat) is an antibiotic used to treat tuberculosis (see Chapter 50). It is used when other drugs have failed. It should only be used along with other anti-tuberculous drugs in order to reduce the development of resistant bacteria. It is not absorbed from the intestine and has to be given by intramuscular injection. Adverse effects: It may produce vertigo, noises in the ears, and disturbances of salt and water balance in the body. It may, rarely, cause irreversible deafness and also progressive kidney damage. Allergic skin rashes and fever and transient liver abnormalities have been reported. It may rarely produce blood disorders. Pain and hardness of the tissues may occur at injection sites. Precautions: It should be given with caution to patients with impaired hearing, impaired kidney function and to those patients with a history of allergy or liver disease. Tests of hearing and balance and tests of liver and kidney function should be carried out at regular intervals during treatment. Do not use in pregnancy. Interactions: Streptomycin, viomycin and any drug that is known to damage hearing, balance or the kidneys. |
| carbamazepine |
carbamazepine (Carbagen, Epimaz, Tegretol, Teril CR, Timonil Retard) is used to treat epilepsy. See Chapter 15. It is also used to treat facial pain (trigeminal neuralgia), nerve pains caused by diabetes, in the prevention of manic depressive psychosis that has not responded to lithium (see p. 21) and occasionally to treat partial pituitary diabetes insipidus. Adverse effects include nausea, vomiting, dizziness, headache, drowsiness, disturbed vision, loss of control over voluntary movements (ataxia), dry mouth, loss of appetite, diarrhoea and constipation. A widespread red rash may occur and elderly patients may become confused and agitated. Rarely it may cause blood disorders, liver damage, serious skin disorders, painful joints, fever, nerve damage, impaired kidney function, enlarged lymph nodes, heart disturbances, swelling of the breasts (in men), milk production, movement disorders (dyskinesia), depression, impotence, aggression, allergic reactions (may affect the lungs), fall in blood sodium level and fluid retention and sensitivity of the skin to the sun’s rays. Precautions: Do not use in patients suffering from a conduction defect of their hearts unless the heart rate is controlled with a pacemaker. Do not use in patients with porphyria (a hereditary disorder of metabolism) or a history of bone-marrow depression causing blood disorders. Use with caution in patients with impaired kidney or liver function, heart disease, skin disorders or who have previously suffered blood disorders caused by other drugs. Carry out blood tests and tests of liver and kidney function at start of treatment and at regular intervals during treatment. Use with caution in pregnancy (risk of damage to spinal cord in the baby, mother should take 5 mg folic acid daily to prevent damage and tests for spinal cord damage should be carried out (alphafetoprotein test and ultrasound scan between 3rd and 6th months of pregnancy). Use with caution in breastfeeding mothers and patients with glaucoma. Avoid suddenly stopping the drug. Watch out for early signs of blood and liver damage and skin disorders. Patients should report immediately to the doctor if he/she develops a fever, sore throat, rash, mouth ulcers, bruising or any bleeding. Interactions: Oral anti-coagulants, MAOIs, combined oral contraceptives, erythromycin, doxycycline, isoniazid, cimetidine, dextropropoxyphene, calcium channel blockers, viloxazine, corticosteroids, anti-epileptic drugs, lithium, benzodiazepines, methadone, theophylline, danazol, haloperidol, fluoxetine, alcohol. |
| carbaryl |
carbaryl (Carylderm) is an insecticide used for treating head lice, see p. 226. Adverse effects: It may irritate the skin. Precautions: Use with utmost caution in infants under six months and in patients with asthma. Use only lotion in patients with eczema. Contact with the eyes and broken or infected skin should be avoided. Preparations containing alcohol should not be used in children, in individuals who suffer from asthma or to treat crabs. To avoid alcoholic fumes, use aqueous solutions. May cause cancer in animals therefore a possible risk in humans. Do not use lotion more than once a week for three weeks at a time. |
| Carbellon |
Carbellon is an antacid which contains magnesium, charcoal and peppermint oil. |
| carbidopa |
carbidopa (in Sinemet) blocks the enzyme that breaks down levodopa in the body (dopadecarboxylase). It is combined with levodopa in co-careldopa (Sinemet) to treat parkinsonism. See Chapter 16. |
| carbimazole |
carbimazole (Neomercazole) is an anti-thyroid drug, see Chapter 43. It reduces the production of thyroid hormone. Adverse effects: These usually occur in the first few months of treatment and include nausea, headache, skin rashes, joint pains and, rarely, jaundice, blood disorders and loss of hair. Precautions: Infants should not be breastfed by mothers taking carbimazole. Patients should report sore throats, skin rashes, mouth ulcers or fever immediately, since these may precede blood disorders by several days. Caution is necessary when using this drug in patients with impaired liver function, and during pregnancy. Do not use in patients with any evidence that the thyroid gland is pressing on the windpipe because the drug may produce enlargement of the thyroid gland in high doses. Interactions: Radioactive iodine. |
| carbocisteine |
carbocisteine (Mucodyne) is used to liquefy sputum (see p. 44) in patients who produce excessive amounts of sticky sputum. It is also used to treat glue ear in children. Adverse effects include stomach and bowel upsets, rash and nausea. Precautions: Do not use in patients with active peptic ulcer. Use with caution in pregnancy and patients with a history of peptic ulcer.
|
| carbomer |
carbomer (polyacrylic acid, Gel Tears, Viscotears liquid gel) is a synthetic acrylic polymer used as eye drops to treat dry eyes.
|
| Carbomix |
Carbomix is a preparation of activated charcoal used to treat acute poisoning by mouth and drug overdosage. Interactions: Antidotes or drugs given to produce vomiting (emetics).
|
| carbonic anhydrase inhibitors |
carbonic anhydrase inhibitors are weak diuretics. See Chapter 29. They include acetazolamide and dichlorphenamide which are used to block the formation of fluid in the eye in the treatment of glaucoma. See p. 53. They are taken by mouth. Dorzolamide is a selective carbonic anhydrase inhibitor which is active when applied topically to the eye (Trusopt eye solution). The use of acetazolamide to treat mountain sickness is of doubtful value – the best treatment is to descend to a lower level and then gradually acclimatize.
|
| carboplatin |
carboplatin (Paraplatin) is an anti-cancer drug (see Chapter 51). Adverse effects: It is a derivative of cisplatin and produces fewer adverse effects such as nausea, vomiting, kidney and nerve damage or damage to hearing. However, it produces more damage to the bone marrow than cisplatin. Very rarely loss of hair, impaired liver function, fever, chill and alteration in taste and allergic reactions may occur. Precautions: See Chapter 51 on anti-cancer drugs.
|
| carboprost |
carboprost (Hemabate) is a prostaglandin (see Chapter 52) used to treat haemorrhage after childbirth due to failure of the womb to contract. Carboprost is recommended when oxytocin combined with ergometrine has failed. Adverse effects include nausea, vomiting, diarrhoea, chills, sweating, headache, dizziness, high temperature, flushing and wheezing. Occasionally, it may cause a rise in blood pressure, breathlessness and fluid on the lungs (pulmonary oedema). It may cause pain and redness at the site of injection. Precautions: It should not be used in women with heart, lung, kidney or liver disease. It should be used with caution if the womb is scarred from previous injury, or if there is acute infection around the uterus (acute pelvic inflammatory disease). It should be used with caution in women with anaemia, asthma, diabetes, epilepsy, high or low blood pressure, glaucoma, or jaundice.
|
| carboxymethylcellulose |
carboxymethylcellulose is used in various drug preparations as a suspending agent, dispersal agent and emulsifying agent. It is used as a bulk laxative, and is widely used in the food industry. It is also used in artificial saliva (Glandosane, Luborant).
|
| cardiac glycosides |
cardiac glycosides see p. 104. Digoxin is the most commonly used cardiac glycoside. It is used to treat heart failure (see Chapter 23) and disorders of heart rhythm (see Chapter 24).
|
| carisoprodol |
carisoprodol (Carisoma) is used to relieve spasm of skeletal muscles (see p. 39). Adverse effects include drowsiness, nausea, headache, constipation, dizziness, lassitude, flushes and skin rashes. Precautions: It should not be used in patients with acute, intermittent porphyria (a hereditary disorder of metabolism), in pregnancy or in breastfeeding mothers. It should be used with caution in patients with impaired kidney or liver function, or with a history of alcoholism or drug dependence. Long-term use should be avoided and the drug should be stopped slowly by gradually reducing the daily dosage. Interactions: Sedatives, sleeping drugs, anticoagulants, corticosteroids, oral contraceptives, phenytoin, griseofulvin, rifampicin, phenothiazines, tricyclic antidepressants.
|
| carmellose sodium |
carmellose sodium is used as a suspending agent in the food industry and in the preparation of gels and ointments. It acts as a protective when applied to the skin or mouth. It is also used as a lubricant in dry eye conditions (Celluvisc).
|
| carminatives |
carminatives are drugs which enable you to belch gas from the stomach. The active constituent is usually a volatile oil which has a pleasant flavour. They work by producing a mild irritation of the lining of the mouth, oesophagus and stomach. This produces salivation, a feeling of warmth, and possibly relaxation of the muscle at the junction between the oesophagus and stomach, thus allowing gas to escape. The volatile oils used as carminatives include dill, peppermint, aniseed, caraway, cloves and ginger. Adverse effects: Essential oils are irritant and excessive use and/or high doses may cause nausea, vomiting and diarrhoea. Overdose by mouth may depress the brain and breathing, or stimulate the brain, producing convulsions. They may irritate the skin and cause contact dermatitis.
|
| carmustine |
carmustine (BiCNU) is an alkylating agent used in the treatment of cancer (see Chapter 51). Adverse effects: These include nausea and vomiting, damage to the bone marrow producing blood disorders, burning at the site of injection and flushing of the skin. Precautions: See Chapter 51.
|
| carnitine |
carnitine (Carnitor) is used to treat carnitine deficiency. Carnitine is present in the normal Western diet and is also manufactured in the liver from the essential amino acids methionine and lysine. It helps to transport long chain fatty acids into cells to be burned to produce energy. Deficiency may be due to a genetic defect, severe liver disease or to excessive loss in kidney dialysis. Symptoms of a low blood sugar and myasthenia gravis (muscle weakness due to neuromuscular abnormality) may occur. Adverse effects include nausea, vomiting, abdominal pain and diarrhoea. These may be related to the dose used. Precautions: Use with caution in patients with impaired kidney function, in pregnancy and in breastfeeding mothers.
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| carvedilol |
carvedilol (Eucardic) is an alpha- and beta-blocker used to treat raised blood pressure. See Chapter 25. Adverse effects include headache, dizziness, fatigue, fall in blood pressure on standing up after sitting or lying down, stomach and bowel upsets, slow pulse rate, cold hands and feet, dry eyes, flu-like symptoms, allergic skin rashes, stuffy nose, wheezing, depressed mood, disturbed sleep, numbness and pins and needless in hands and feet, disorders of liver function, blood disorders, angina and heart failure, heart block. Precautions: Do not use in patients with moderate or severe heart block, severe slowness of the pulse, uncontrolled heart failure, asthma, chronic obstructive airways disease, impaired liver function, pregnancy or breastfeeding mothers. Use with utmost caution in patients with impaired heart function, overworking of the thyroid gland or diabetes. Interactions: General anaesthetics, class I anti-arrhytmics, verapamil, digoxin, rifampicin.
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| cascara |
cascara (Rhuaka) is the dried bark of Rhamnus purshiana. It is a stimulant laxative used to treat constipation. See Chapter 21.
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| castor oil |
castor oil is used as a stimulant laxative to treat constipation. See Chapter 21. Large doses may produce nausea, vomiting, colic and severe loss of fluid with purgation. It is also used as a soothing application in eye drops and skin ointments.
|
| Ceanel Concentrate |
Ceanel Concentrate (shampoo for psoriasis) contains phenylethyl alcohol, cetrimide and undecenoic acid, see entry on each drug. Avoid contact with eyes.
|
| celecoxib |
celecoxib (Celebrex) is a non-steroidal anti-inflammatory drug used to treat osteoarthritis and rheumatoid arthritis. See Chapter 32. Adverse effects include fluid retention, stomach and bowel upsets, dizziness, insomnia, upper respiratory tract disorders, skin rash. Precautions: Do not use in patients with a history of allergy to sulphonamides or NSAIDS, active peptic ulcer or bleeding from the stomach or bowel, inflammatory bowel disease, severe kidney or liver damage, severe congestive heart failure, in pregnancy (effective contraception must be used) or while breastfeeding. Use with caution in the elderly and black patients – use low starter doses. Also use with caution in patients with impaired kidney or liver function, a history of stomach or bowel disorders, heart failure or raised blood pressure. |
| cellulose |
cellulose is used as a bulking and suspending agent in the manufacture of tablets and liquid medicines.
|
| cephalosporins |
cephalosporins are discussed in Chapter 46. Adverse effects: The commonest adverse effects produced by the cephalosporins are allergic reactions. Any one of the cephalosporins is likely to cause allergic reactions, which are similar to those produced by the penicillins. This may be because they share a similar chemical structure. Immediate allergic reactions may occur, causing a severe allergic emergency (anaphylaxis), wheezing and nettle-rash (urticaria). A delayed allergic reaction comes on after several days and produces a measles-like rash with fever. Swollen glands and fever may occur on their own without a rash. About 10% of patients allergic to penicillins will be allergic to the cephalosporins, but there is no skin test to predict this cross-allergy. About 5% of patients will be allergic to cephalosporins. Cephaloridine (a first-generation cephalosporin) may occasionally cause kidney damage, particularly when given in a high dose and when given with a loop diuretic drug such as frusemide or ethacrynic acid. Other cephalosporins have caused kidney damage in patients whose kidney function is already impaired. The risk of kidney damage is increased in elderly people if a cephalosporin is given with other antibiotics that may cause kidney damage, for example, gentamicin or tobramycin. Several of the cephalosporins interfere with blood-clotting factors and may occasionally cause bleeding, particularly in elderly and debilitated patients. Cephalosporins may occasionally cause nausea, vomiting and diarrhoea and, very rarely, blood disorders, liver damage, skin rashes, a severe form of colitis (pseudomembranous colitis) which is more likely to occur with higher doses, jaundice, nervousness, hyperactivity, sleep disturbances, confusion, headache, dizziness, and superinfection. Injections of cephalothin may be painful. Precautions: Cephalosporins should not be used in an individual who has had an allergic reaction to any of the cephalosporins. They should not be used in people who suffer from porphyria (a hereditary disorder of metabolism). They should be used with caution in anyone allergic to penicillins or who have impaired kidney function. Cephalosporins may give false positive tests for sugar in the urine and for haemolytic anaemia (Coombs’ test). Adverse effects from cephalosporins may be more frequent and severe in elderly people because they may have impaired kidney function. They should be used with caution in pregnancy and in breastfeeding mothers. Interactions: aminoglycosides, loop diuretics. Antacids reduce absorption of cefpodoxime; cephamandole causes disulfiram-like reaction with alcohol; antacids reduce absorption of cefpodoxime; cephamandole increases anticoagulant effects of warfarin and nicoumalone; H2-blockers cause reduced absorption of cefpodoxime; probenecid reduces urinary excretion of cephalosporins causing increased blood levels.
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| Cerumol ear drops |
Cerumol ear drops contain paradichlorobenzene and chlorbutanol in arachis oil. It is used to dissolve ear wax (see p. 48). Do not use if ear drum is perforated or if patient has eczema or dermatitis of the ear (otitis externa).
|
| cetalkonium |
cetalkonium (in Bonjela, in Teejel) is used as an antiseptic. It has effects like cetrimide.
|
| cetraben |
cetraben is a skin softening cream containing white soft paraffin and light liquid paraffin.
|
| cetrimide |
cetrimide (in Ceanel Conc, Cetavlex, in Drapolene, in Hibicet Conc, Siopel, Steripod Yellow, Tisept) is a surface-active drug with antiseptic, emulsifying and detergent properties. It is used as a skin-cleansing agent in numerous preparations and also in shampoos. Some patients may develop sensitivity to cetrimide after repeated applications. It may cause the skin of the scalp to become very dry.
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| cetrorelix |
cetrorelix (Cetrotide) is a luteinising hormone releasing hormone (LHRH) blocker (see p. 169) used in the treatment of female infertility. It is used to prevent premature ovulation in controlled ovarian stimulation. Adverse effects include pain, swelling and redness at the site of injection, nausea, headache. Precautions: Do not use in patients with moderate or severe kidney or liver damage, patients who are post menopausal, pregnant or breastfeeding.
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| cetyl alcohol |
cetyl alcohol is used in the preparation of ointments and creams.
|
| cetylpyridinium |
cetylpyridinium (cetylpyridinium chloride) is used as an antiseptic. It has effects similar to those described under cetrimide. It is used in throat lozenges, gargles and teething gels.
|
| chamomile |
chamomile (chamomile flowers, in Kamillosan) has a pleasant aromatic odour and appears in some cough medicines, indigestion remedies and hair preparations.
|
| Chemotherapy |
Chemotherapy see Chapter 51.
|
| chloral hydrate |
chloral hydrate (Welldorm elixir) is a sleeping drug (see Chapter 1). Adverse effects include headache, nausea, dizziness, excitement, drowsiness, delirium, disorientation, paranoia, skin rashes and blood disorders. Precautions: It irritates the stomach and must be taken well diluted. Chloral hydrate should not be used in pregnancy, in breastfeeding mothers, in patients with severely impaired liver, heart or kidney function or with peptic ulcers. If a patient taking chloral hydrate regularly has a drink of alcohol there may be a fall in blood pressure causing flushing, rapid beating of the heart and faintness. It should be used with caution in patients with porphyria (a hereditary disorder of metabolism). Drug dependence: It produces drug dependence of the barbiturate/alcohol type and increases the effects of alcohol. It may affect the ability to drive and operate moving machinery. Interactions: alcohol, sedatives, sleeping drugs, anticoagulants.
|
| chlorambucil |
chlorambucil (Leukeran) is an anti-cancer drug (see Chapter 51). Adverse effects: The most frequent adverse effect is damage to the bone marrow, producing severe blood disorders. Nausea, vomiting, diarrhoea, ulceration of the mouth occur infrequently and very rarely it may cause lung damage, liver damage, fever, allergic reactions, skin rashes, nerve damage and cystitis. Precautions: It should not be used in pregnancy or in breastfeeding mothers or in patients with porphyria (a hereditary disorder of metabolism), or when there is a risk that bone-marrow function is decreased (e.g. within four weeks of radiotherapy or another anti-cancer drug).
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| chlorbutanol |
chlorbutanol (chlorbutol, in Cerumol, in Frador, in Monphytol) is a mild sedative and local pain-reliever. It has been used in anti-motion sickness preparations but is of doubtful value. It also has antibacterial and antifungal properties. It is used as a preservative in some injections, eye drops and ear drops.
|
| chlorhexidine |
chlorhexidine (Cepton) is an antiseptic/disinfectant active against a wide range of bacteria, some fungi and some viruses. Adverse effects: It may, rarely, cause allergic skin reactions, and strong solutions may irritate the skin and eyes. The use of mouthwashes and dental preparations that contain chlorhexidine may discolour the teeth and tongue. They may produce a transient burning sensation of the tongue and disturbances of taste. Rarely, mouthwashes may cause ‘skinning’ of the mouth and swollen salivary glands. Precautions: It should not be used on sensitive tissue (e.g. in ear drops) and it may be absorbed into contact lenses which may then irritate the eyes. Oral gel containing chlorhexidine should not be used at the same time as dentifrices.
|
| chlormethine(mustine) |
chlormethine(mustine) (mustine hydrochloride, mechlorethamine) is an anti-cancer drug. See Chapter 51. Adverse effects include nausea, vomiting, diarrhoea, peptic ulcer, drowsiness, psychosis, loss of hair, deafness and noises in the ears (tinnitus), several months without a period (amenorrhoea), reduced sperm count and skin rashes. Damage to the bone marrow may occur, leading to severe blood disorders. Injections may produce pain, irritation and inflammation of the vein at the injection site. Precautions: See Chapter 51 on anti-cancer drugs.
|
| chlorofluorocarbons |
chlorofluorocarbons (CFCs) are gradually being replaced by hydrofluoroalkanes (HFAs) as propellants used in pressurized (aerosol) inhalations in the treatment of asthma.
|
| chloroform |
chloroform is no longer used as an inhalation anaesthetic because of its toxicity. Chloroform water and spirit are still used in some preparations to treat wind, as a flavouring agent, or as a preservative, but because chloroform may cause cancer in animals there are doubts about the safety of using it regularly for prolonged periods of time.
|
| chloroquine |
chloroquine (chloroquine phosphate, chloroquine sulphate, Avloclor, Nivaquine) is used to prevent and treat malaria, amoebiasis of the liver, and giardiasis. It is also used to treat rheumatoid arthritis and similar disorders (see Chapter 32). Adverse effects include itching (pruritus), headache, stomach and bowel upsets, skin rashes and visional disturbances. Large doses over long periods (as used to treat rheumatoid arthritis) may produce damage to the eyes (degeneration of the retina and opacities of the cornea). White patches on the skin due to loss of pigment may occur, and it may also cause whitening of the hair, thinning of the hair, blood disorders and allergic reactions. It may cause psoriasis to flare up. Convulsions and mental breakdown may, very rarely, occur. Adverse effects are rare with doses used to treat malaria. Precautions: Use with caution in patients with epilepsy, porphyria (a hereditary disorder of metabolism), impaired kidney or liver function, psoriasis, blood disorders, G6PD deficiency, (it should not be used to treat rheumatoid arthritis in pregnancy), and in breastfeeding mothers. Eye tests should be carried out before and at regular intervals during treatment. Interactions: Antacids, anti-epileptic drug.
|
| chloroxylenol |
chloroxylenol (in Rinstead gel, in Zeasorb) is used as an antiseptic and disinfectant. It is less toxic than phenol. Wet dressings in contact with the skin may produce allergic reactions.
|
| chlorquinaldol |
chlorquinaldol (in Locoid C) has antibacterial and antifungal properties and is used in the treatment of skin infections.
|
| choline |
choline is an essential factor in nutrition but it cannot be classified as a vitamin. It is the basic constituent of lecithin. Choline functions as a methyl donor in metabolism. The daily requirement has not been established and there are no valid reports of its effectiveness in any treatment. Adverse effects include nausea, vomiting, diarrhoea, depression, incontinence and a fishy odour.
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| choline salicylate |
choline salicylate is used to relieve pain in local applications. It has effects similar to aspirin. It is used in Audax ear drops and Bonjela and Teejel to treat mouth ulcers.
|
| cholinesterase |
cholinesterase is an enzyme which breaks down acetylcholine at parasympathetic nerve endings. See Chapter 9.
|
| choriogonadotropin |
choriogonadotropin (Ovitrelle) is used to treat infertility. Adverse effects include swelling and redness at site of injection, headache, tiredness, stomach and bowel upset, abdominal pain and over-stimulation of the ovaries (ovarian hyperstimulation). Precautions: Do not use in patients with cancer of the hypothalamus, pituitary gland, ovaries, uterus or breast, undiagnosed vaginal bleeding, ectopic pregnancy in previous three months, blood clots (thromboembolic disorders) or in post-menopausal women. |
| ciclosporin |
ciclosporin (cyclosporin) (Neoral, Sandimmun, Sang Cya) is a potent immunosuppressant (see Chapter 17). It is used to prevent rejection in tissue and organ transplants. It is also used in the treatment of severe atopic eczema, severe psoriasis and severe active rheumatoid arthritis that have not responded to conventional treatments. Adverse effects include impaired kidney function (in first few weeks) and occasionally structural damage to the kidneys in patients on long-term treatment. It may cause tremor, overgrowth of body hair, raised blood pressure (especially in heart transplant patients), impaired liver function, overgrowth of the gums, fatigue, burning sensations in the hands and feet (usually during first week), rash (possibly allergic), anaemia, headache, raised blood potassium levels, raised blood uric acid levels, gout, raised blood cholesterol and magnesium levels, nerve damage, weight increase, fluid retention, confusion, painful or absent periods, muscle damage, muscle cramps and weakness, inflammation of the bowel, blood disorders, malignant tumours, lymph gland abnormalities and brain malfunction (encephalopathy). When given with spironolactone, male patients may develop enlargement of the breasts. Precautions: Monitor kidney function, liver function, blood pressure, blood chemistry and blood cholesterol at regular intervals. Use with caution in pregnancy, in breastfeeding mothers and in patients with raised blood potassium, uric acid or cholesterol levels or with porphyria (a hereditary disorder of metabolism). If treating rheumatoid arthritis do not use ciclosporin in patients with impaired kidney function, raised blood pressure not under control with anti-blood pressure drugs, infections not under control or patients suffering from malignant cancers. Carry out tests of kidney function before treatment (at least twice) and monitor every two weeks for three months and then every two weeks after that. The dose of the drug should be adjusted according to the results of kidney function tests that measure creatinine clearance. Monitor blood pressure and stop treatment if it goes up and cannot be controlled by anti-blood pressure drugs. Monitor liver function if given with an NSAID. When treating atopic eczema or psoriasis precautions are as above. Avoid excessive exposure to the sun’s rays and the use of UVB and PUVA. If patients with atopic eczema develop herpes simplex (cold sores) allow to clear before starting treatment and stop if it develops and is severe during treatment. Interactions: Systemic antibiotics, live vaccines, phenytoin, ketoconazole, fluconazole, itraconazole, erythromycin, rifampicin, carbamazepine, barbiturates, calcium channel blockers, colchicine, oral contraceptives, propafenone, prednisolone, methyl prednisolone, potassium supplements, potassium-sparing diuretics, NSAIDs, grapefruit juice. |
| cidofovir |
cidofovir (Vistide) is used in combination with probenecid in cytomegalovirus (CMV) inflammation of the retina in AIDS patients. See Chapter 48. Adverse effects include protein in the urine, blood disorders, weakness, creatinine increase, fever, hair loss, nausea, rash, kidney failure (sometimes fatal), hearing disturbances, inflammation of the pancreas, lack of muscle tone in the eye. Precautions: Do not insert into the eye or use in patients with kidney damage, in pregnancy or while breastfeeding. Use with caution in patients with diabetes. |
| cilazapril |
cilazapril (Vascace) is used to treat raised blood pressure (see Chapter 25). It is also used with digoxin and/or diuretics to treat chronic heart failure (see Chapter 23). It is an ACE inhibitor (see p. 106) which is rapidly metabolized in the lining of the stomach and intestine and in the liver to its active metabolite, cilazaprilate. Adverse effects include headache, dizziness, fatigue, nausea, indigestion, coughing and skin rashes. Rarely it may cause allergic reactions (angioedema) and blood disorders. Precautions: Do not use in patients with fluid in the abdomen (ascites), obstruction to the flow of blood from the heart into the main artery (e.g. aortic stenosis), in pregnancy or in breastfeeding mothers. Do not use in patients with hypertrophic cardiomyopathy. Use with caution in patients with impaired kidney or liver function, congestive heart failure, salt or fluid loss, during surgery or anaesthesia. Do not use in patients who have suffered from allergic reactions after previous ACE inhibitor treatment. Interactions: Potassium-sparing diuretics, NSAIDs, potassium supplements, anti-diabetic drugs, lithium, desensitization preparations, corticosteroids, procainamide. |
| Cilest |
Cilest is a combined oral contraceptive drug. See p. 189.
|
| cimetidine |
cimetidine (Acitak, in Algitec, Dyspamet, Galenamet, Tagamet, Zita) is an H2 antihistamine blocker used to treat stomach and duodenal ulcers, including those produced by non-steroidal anti-inflammatory drugs (NSAIDs), see Chapter 19. It is also used to treat acid reflux (see p. 85) and other disorders where a reduction in stomach acid is beneficial. Adverse effects include diarrhoea, tiredness, dizziness. Occasionally it may cause confusion (especially in the elderly) and liver damage. Very rarely, it may cause headache, painful muscles and joints, blood disorders, changes in kidney function, pancreatic function and heart rate, heart block and loss of hair. In men, prolonged use of high doses may cause enlargement of the breasts and impotence. These feminization effects are reversible when the drug is stopped. Precautions:Do not use in patients who are allergic to it. Use with caution in patients with impaired liver or kidney function (reduce the dose) and exclude stomach cancer before starting treatment because the drug may mask the symptoms. Use with caution in pregnancy and in breastfeeding mothers. Interactions: Cimetidine affects enzymes in the liver that metabolize certain drugs. It may interact with the following drugs: Oral anticoagulants, phenytoin, theophylline, lignocaine, diazepam, chlordiazepoxide, propranolol, imipramine, morphine.
|
| cinchocaine |
cinchocaine (in Proctosedyl, in Scheriproct, in Ultraproct, in Uniroid HC) is a local anaesthetic.
|
| ciprofloxacin |
ciprofloxacin (Cilovan eye drops, Ciproxin) is a 4-quinoline antibacterial drug, see p. 240. Adverse effects include nausea, vomiting and diarrhoea, dizziness, headache, tremor, confusion, convulsions, blurred vision, joint pains, sleep disturbances, tiredness and allergic reactions (skin rashes and itching). It may affect ability to perform skilled tasks (e.g. motor driving) and, very rarely, cause disturbed liver and kidney function, sensitivity of the skin to sunlight, severe skin rashes, transient hearing loss, inflammation of a tendon (stop treatment and rest the limb), impaired taste and smell, blood disorders, Stevens-Johnson syndrome (a severe form of inflammatory skin disease), inflammation of the bowel and rapid beating of the heart. Injections may cause pain and inflammation at the site of injection. Precautions: It should not be used in pregnancy and breastfeeding mothers and preferably not in children or growing adolescents. It should be used with caution in patients with epilepsy or severe kidney impairments. Patients should drink plenty of fluids. It should be used with caution in patients with G6PD deficiency. Interactions: theophylline, cyclosporin, magnesium, aluminium or iron salts, anticoagulants, NSAIDs, glibenclamide, opiate pain-relievers, probenecid. Ciprofloxacin is included in Ciloxan eye drops used to treat corneal ulcers and bacterial infections of the eyes. Adverse effects include transient local irritation, bitter taste and skin rashes (stop immediately). Precautions: Do not wear soft contact lenses whilst on treatment. Use with caution in pregnancy and breastfeeding mothers.
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| cisatracurium |
cisatracurium (Nimbex injections) is a non-depolarizing muscle relaxant (see p. 39) used during surgery and intensive care. Precautions: Do not use in pregnancy. Use with caution in patients with myasthenia gravis (muscle weakness due to neuromuscular abnormality), allergy to neuromuscular blocking drugs, burns, or who have disturbances of their serum electrolytes. Interactions: General anaesthetics, other non-depolarizing muscle relaxants, suxamethonium, antibiotics, anti-arrhythmic drugs, diuretics, ganglion blockers, magnesium and lithium salts, phenytoin, carbamazepine.
|
| cisplatin |
cisplatin is an anti-cancer drug (see Chapter 51). It is of particular use in cancer of the testicles and cancer of the ovaries (Platinex). Adverse effects include severe nausea and vomiting, damage to the bone marrow producing blood disorders, damage to the kidneys, damage to the nerves of the ear producing tinnitus and deafness, damage to the nerves producing pins and needles in the arms and legs, loss of taste, allergic reactions characterized by swelling of the face, wheezing, rapid beating of the heart and falling blood pressure within a few minutes of drug administration. It may also cause a rise in blood uric acid levels and a fall in magnesium levels. Precautions: It should not normally be used in patients with impaired function of their kidneys, bone marrow, nervous system or hearing. It should not be used in patients with a history of allergy to cisplatin or other platinum-containing compounds. It should not be used in pregnancy or in breastfeeding mothers. It may affect fertility. Since severe allergic reactions may occur in the first few minutes of administration, adrenaline(epinephrine), a corticosteroid and an antihistamine drug should always be at hand. Kidney function, the nervous system and hearing should be monitored throughout the period of treatment.
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| citalopram |
citalopram (Cipramil) is a 5HT re-uptake blocker used to treat depression. See Chapter 4. Adverse effects include nausea, dry mouth, sleepiness, tremor and sweating. Precautions: Use with caution in pregnancy, in breastfeeding mothers and in patients with severe impairment of kidney or liver function. Interactions: MAOIs, 5HT stimulants, lithium, tryptophan and antipsychotic drugs. Also see adverse effects and precautions listed under fluoxetine (Prozac).
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| Citramag |
Citramag is an osmotic laxative (see Chapter 21). It is an effervescent powder of magnesium citrate in a sachet. The contents are dissolved in water and taken by mouth to empty the bowel the day before X-ray of, or surgery on, the bowel. It should be used with caution in patients with kidney failure and in the elderly. Patients should drink plenty of fluids and have a low-residue diet the day before the X-ray or surgery.
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| cladribine |
cladribine (Leustat) is an anti-cancer drug. See Chapter 51. It is used to treat hairy cell leukaemia. Adverse effects include damage to the bone marrow producing blood disorders, kidney damage and nerve damage. It may cause fatigue, fever, headache, rash, fluid retention (oedema), rapid beating of the heart, affect breathing and cause muscle pains and cough. Precautions: Do not use in pregnancy or in breastfeeding mothers. Use with caution in patients with impaired kidney or liver function or severe bone marrow damage. Blood counts and kidney and liver function tests must be carried out at regular intervals. Stop the drug at the earliest signs of kidney or nerve damage. Interaction: Other drugs that may damage the bone marrow.
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| clarithromycin |
clarithromycin (in Heliclear, in Helimet, Klaricid) is a semi-synthetic derivation of the macrolide antibiotic erythromycin (see p. 236). It is better absorbed than erythromycin because it is not affected by the acid in the stomach. Adverse effects include nausea, vomiting, diarrhoea, abdominal pains, headache and skin rashes. Precautions: It should be used with special caution in patients with impaired kidney or liver function, in pregnancy and in breastfeeding mothers. Interactions: Theophylline, oral anticoagulants, digoxin, carbamazepine, terfenadine.
|
| clavulanic acid |
clavulanic acid has little antibacterial action of its own, but enhances the effects of penicillins. By inactivating penicillinase produced by bacteria, the resistance of these bacteria to penicillins is destroyed. It is combined with amoxycillin in Augmentin and with ticarcillin in Timentin.
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| clindamycin |
clindamycin (Dalacin C) is a lincosamide antibiotic (see p. 237). Adverse effects: It may cause nausea, vomiting, severe diarrhoea and inflammation of the bowel. It may, rarely, cause blood disorders and jaundice. Precautions: Do not use in patients who are allergic to lincomycin. Use with caution in patients with impaired kidney or liver function. Stop if severe diarrhoea develops. Interactions: Neuromuscular blocking drugs. Clindamycin is used as cream (Dalacin cream) to treat bacterial vaginal infection. Applied to the vagina it may cause irritation and it may be absorbed into the blood-stream to cause stomach and bowel upsets, severe diarrhoea and inflammation of the bowel (stop immediately). Barrier contraceptives may be less effective. Do not use if the patient is allergic to lincomycin. Clindamycin is also used as a roll-on lotion (Dalacin T) to treat acne. It may cause dry skin or dermatitis.
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| clioquinol |
clioquinol (iodochlorhydroxquinoline) is an antiseptic (see p. 214). It is used in Betnovate C, Locorten-Vioform, Synalar C, Vioform-hydrocortisone. Adverse effects: It stains the skin yellow and may cause irritation. Precautions: It should not be taken by mouth to treat traveller’s diarrhoea because it may damage the nerves of the arms, legs and eyes (myelo-optico-neuropathy).
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| clobetasol |
clobetasol (clobetasol propionate, Dermovate, in Dermovate-NN) is a very potent corticosteroid used in skin applications to treat eczema and psoriasis. See corticosteroid skin applications p. 211.
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| clobetasone |
clobetasone (clobetasone butyrate, Eumovate, in Trimovate) is a moderately potent corticosteroid used in skin applications to treat eczema and psoriasis. See corticosteroid skin applications, p. 211. It is also used in Cloburate eye drops to treat non-infected, inflammatory eye disorders.
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| clofazimine |
clofazimine (Lamprene) is used in the treatment of leprosy. Adverse effects: It may cause stomach and bowel upsets, dry eyes, weight loss, dry skin, itching, and it may colour the urine, skin, hair and secretions red. Precautions: Use with caution in pregnancy, breastfeeding mothers, patients with impaired kidney or liver function, and patients with diarrhoea and abdominal pain.
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| clomethiazole |
clomethiazole (Heminevrin) is used as a sleeping drug (see Chapter 1), to treat epilepsy (see Chapter 15) and alcohol withdrawal symptoms. Adverse effects include headache, nausea, vomiting, nasal congestion and sneezing, sore eyes, dizziness, rashes, stomach and bowel upsets, allergic reactions, drowsiness, excitement and confusion. Precautions: Do not use in breastfeeding mothers or in patients with severe chest trouble or in alcoholics who continue to drink. Use with caution in patients with long-term chest complaints, impaired kidney or liver function. It may increase the effects of alcohol and other depressant drugs. It may trigger off depression in someone who suffers from episodes of severe depressive illness (manic-depressive psychosis). It may interfere with the ability to drive or operate machinery. Drug dependence of the barbiturate/alcohol type may develop quickly in certain individuals. Avoid prolonged use and sudden withdrawal. Interactions: alcohol, sedatives, sleeping drugs, diazoxide, propranolol, cimetidine.
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| clomifene |
clomifene (clomiphene citrate, Clomid) is used to treat infertility caused by failure to ovulate. It is an anti-oestrogen (see p. 172). Adverse effects include hot flushes, nausea, vomiting, dizziness, headache, depression and mood changes, insomnia, breast tenderness, weight gain, abdominal discomfort, ovarian enlargement, skin rashes, hair thinning, visual disturbances (stop immediately), spotting, heavy periods and rarely, convulsions. Over-stimulation (hyperstimulation) of the ovaries may occur (stop treatment if this happens). Precautions: It should not be used in patients with liver disease, large ovarian cysts, cancer of the womb or bleeding from the womb, or in pregnancy. Patients should be warned of the possibility of multiple births. Pregnancy should be tested for before and during treatment. Use with caution in polycystic ovary syndrome. Monitor for ovarian hyperstimulation (OHSS), ectopic pregnancy, multiple birth and visual symptoms. Do not use for longer than six menstrual cycles because of the risk of cancer of the ovary if treated for more than six months.
|
| clonidine |
clonidine (Catapres, Dixarit) is a central alpha stimulant used to treat raised blood pressure (see Chapter 25), prevent migraine (see Chapter 34) and relieve menopausal flushing (see p. 174). Adverse effects include drowsiness, dry mouth, dizziness, headache and constipation. Occasionally it may cause fluid retention, mood changes, disturbed sleep, vivid dreams and impotence. Precautions: Do not use in patients with mental depression. Use with caution in patients with porphyria (a hereditary disorder of metabolism) or disorders of the circulation. Treatment should be stopped gradually over several days in order to avoid a sudden rebound rise in the blood pressure. Use with caution in breastfeeding mothers. Interactions: Tricyclic antidepressants, other anti-blood pressure drugs, alpha-blockers, sedatives, sleeping drugs (and other drugs that depress brain function). It may impair ability to drive because it causes drowsiness.
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| clopidogrel |
clopidogrel (Plavix) is an anti-platelet drug used to treat strokes (from day 7 until less than 6 months), heart attack (from a few days until less than 35 days), or established peripheral artery disease. See Chapter 28. Adverse effects include bleeding, stomach and bowel upsets, skin reactions and nervous system, liver, gall bladder and blood disorders. Precautions: Do not use in patients with severe liver damage, active bleeding (eg. from a peptic ulcer or bleeding from the brain), unstable angina, acute stroke of less than 7 days, in pregnancy or while breastfeeding. Use with caution in patients with moderate impairment of liver function, risk of bleeding (eg. in injury, surgery, acute peptic ulcer or bleeding inside the eyes). Unusual bleeding should be reported.
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| clotrimazole |
clotrimazole (Canasten, Candiden) is an antifungal drug (see Chapter 42) used in Canesten preparations to treat vaginal infections, outer ear infections and skin infections, in Lotriderm preparations to treat fungal skin infections and in Masnoderm to treat fungal skin infections and vaginal infections. Applied to the skin, ears or vagina it may rarely cause a local burning sensation and irritation and very rarely allergic reactions.
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| co-dergocrine |
co-dergocrine (co-dergocrine mesylate, Hydergine) is an ergot alkaloid used to stimulate brain cells in elderly patients with mild to moderate dementia (see p. 119). Adverse effects include nausea, vomiting, flushing, headache, cramps in the abdomen, blocked nose, dizziness, rash, and fall in blood pressure on standing up after lying or sitting down (may cause faintness and light-headedness). Precautions: Use with caution in patients with severe slowing of the heart rate.
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| co-simalcite |
co-simalcite preparations (Altacite Plus) contain the anti-wind surfactant drug, activated dimethicone, and the antacid hydrotalcite. They are used to treat wind and indigestion υ antacids and see Chapter 19 on drugs used to treat indigestion and peptic ulcers.
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| coal tar extract |
coal tar extract (in Alphosyl, in Alphosyl HC, in Clinitar, in Exorex, in Polytar, in Pragmatar) relieves itching of the skin and it has mild antiseptic properties. Adverse effects include irritation of the skin, acne-like eruptions and sensitization of the skin to the sun’s rays. Rarely, it may produce an allergic rash. Precautions: Avoid contact with eyes, or broken or inflamed skin. It may stain the skin, hair and fabrics and it smells of tar. It is used to treat eczema, psoriasis and dandruff.
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| COC |
COC (combined oral contraceptives). See Chapter 41.
|
| cocaine |
cocaine is the oldest local anaesthetic, but because of adverse effects and risk of drug dependence it is hardly ever used except for local application to the eyes, ears or nose. Unlike all other local anaesthetics it constricts small blood vessels and need not be given with adrenaline(epinephrine). Adverse effects: Some people have an idiosyncrasy to cocaine and may become seriously ill, even after a small dose. They develop headaches, faintness and may suddenly collapse and die. In other patients it may cause the general adverse effects of any local anaesthetic – excitation, restlessness, nausea, yawning and vomiting which may be followed by pallor, sweating, fall in blood pressure, twitching, convulsions and unconsciousness. Precautions: It should not be given to patients with myasthenia gravis (muscle weakness due to neuromuscular abnormality) and it should be given with caution to patients with disordered heart rhythm or with impaired liver function.
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| Cocois |
Cocois scalp ointment contains coal tar, salicylic acid and sulphur in a coconut oil moisturising base. It is used to prevent itching and to remove dead skin in the treatment of chronic eczema and psoriasis of the scalp. Adverse effects: it may irritate the skin. Precautions: Do not use if scalp is acutely infected or in pustular psoriasis.
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| coconut oil |
coconut oil is used to form absorbable ointment bases for scalp applications. It is used in the manufacture of ‘marine’ soaps.
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| cod liver oil |
cod liver oil is a rich source of vitamins A and D and essential unsaturated fatty acids. It is also included in some soothing ointments, e.g. Morhulin.
|
| codeine |
codeine (codeine phosphate, codeine sulphate) is an opiate pain-reliever (see Chapter 30). It is a weak cough suppressant (see Chapter 11) and it is also of value in treating diarrhoea (see Chapter 20). Adverse effects: The commonest adverse effects are constipation, nausea, vomiting, dry mouth, dizziness and drowsiness. Very rarely, skin rashes may occur in patients who are allergic to codeine. Precautions: Codeine should not be given to patients suffering from severe respiratory disorders (e.g. chronic bronchitis). It should be used with caution in patients suffering from an under-active thyroid gland, chronic liver disease, in the elderly and in women in labour. Individuals may become tolerant to effects of codeine. Drug dependence: Prolonged use of high doses may rarely produce dependence of the morphine type: see p. xxix. Interactions: Alcohol, MAOIs, sleeping drugs, sedatives and other drugs that depress brain function.
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| colchicine |
colchicine is used to treat acute gout (see Chapter 33). Adverse effects: Large doses quickly produce diarrhoea, nausea, vomiting and abdominal pains. Bone-marrow damage (causing blood disorders), muscle and nerve damage, kidney damage, loss of hair and skin rashes may, rarely, occur with prolonged use. Irritation and thrombophlebitis (inflammation of the vein) may, rarely, occur at the site of injection. Precautions: Colchicine should be given with caution to the elderly and debilitated and to patients who suffer from impaired heart, liver or kidney function, or disorders of the stomach or intestine (e.g. colitis). Use with the utmost caution in pregnancy and breastfeeding mothers. Interactions: Cyclosporin.
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| colecalciferol |
colecalciferol (in Adcal D3, in Cacit D3, in Caleos, in Calcichew D3) is vitamin D3. See Chapter 36.
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| colestyramine |
colestyramine (cholestyramine, Questran, Questran Light) breaks down bile salts in the intestine and is used to treat raised cholesterol and blood fat levels (see Chapter 26). It is also used to break down bile salts in patients who suffer from diarrhoea associated with surgical removal of part of the small intestine, Crohn’s disease or radiation treatment, and to relieve itching in patients with a partial obstruction of the bile system. Adverse effects include constipation, heartburn, wind, nausea, vomiting and diarrhoea. It may rarely cause skin rashes and high doses may cause fats to appear in the stools (steatorrhoea). Long-term use may interfere with the absorption of fat-soluble vitamins (A, D, E and K) – lack of vitamin K may result in a tendency to bleed easily. Precautions: Do not use if the bile system is obstructed. Use with caution in pregnancy and in breastfeeding mothers. Patients on long-term treatment should be given supplements of vitamins A, D, E and K. Interactions: Digitalis, antibiotics, diuretics, warfarin, thyroxine. Take any other drug 1 hour before or 4–6 hours after taking Questran or Questran Light. Questran Light contains the artificial sweetener aspartane therefore use with caution in patients with phenylketonurea.
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| colfosceril |
colfosceril (Exosurf ) is a synthetic surfactant (lubricant) used to treat respiratory distress syndrome (RDS), a hyaline membrane disease in premature babies. In this condition the lungs are immature and because of a lack of natural lubricant (surfactant), the air sacs collapse when the baby breathes out. Colfosceril acts like the natural surfactant; it stops the air sacs from collapsing, improves exchange of gases and reduces the risks of mechanical ventilation. It may cause bleeding in the lungs. The baby must be carefully monitored to avoid too much oxygen entering the blood.
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| Colifoam |
Colifoam aerosol contains hydrocortisone. It is used to treat inflammatory disorders of the bowel and rectum. Adverse effects see Chapter 37 on corticosteroids. Precautions: Do not use if there is obstruction, perforation or abscess of the bowel and do not use if there is a tuberculous, fungal or viral infection of the bowel. Use with utmost caution in pregnancy and severe ulcerative disease. Avoid prolonged use.
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| colistimethate sodium |
colistimethate sodium (colistin, Colomycin) is a polymyxin antibiotic. Adverse effects: by mouth and injection include myasthenia gravis (muscle weakness due to neuromuscular abnormality), vertigo, and pins and needles round the mouth and in the hands and feet. Very rarely, it may cause slurred speech, confusion, visual disturbances, kidney damage and the breathing to stop for a moment (apnoea). Precautions: Do not use in patients with myesthenia gravis, in pregnancy or in breastfeeding mothers. The dose should be reduced in patients with impaired kidney function. Use with caution in patients with porphyria (a hereditary disorder of metabolism).
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| colophony |
colophony is obtained from volatile oils from various species of pine. It is an ingredient of some collodions and plaster-masses and was previously used in ointments for treating boils, etc.
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| Contigen |
Contigen is purified collagen from the skin of cattle. It comes in pre-filled syringes and is used to inject into the neck of the bladder to tighten it up in the treatment of patients suffering from incontinence of urine due to ineffective closure of the bladder neck (see p. 249). Adverse effects include urinary tract infections, retention of urine and discomfort and bleeding at the site of injection. Precautions: Do not use in patients allergic to bovine collagen (skin tests come free with the treatment kits) or to bovine products. Do not use in patients who suffer from severe allergies, a history of autoimmune disease, acute infection of the bladder or urethra or stricture of the bladder neck or urethra. Perform skin tests for allergy four weeks before procedure and repeat if results are doubtful. Do not use in pregnancy or breastfeeding mothers. Patients should report immediately if they develop any swelling or discomfort after the procedure has been carried out.
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| contraceptives, oral |
contraceptives, oral see Chapter 41.
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| copper |
copper acts as a contraceptive when present in the uterus (IUD). Copper is an essential trace element in the diet. There is no evidence that wearing a copper bracelet for the treatment of rheumatic disorders has any effect.
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| corticosteroid skin applications |
corticosteroid skin applications see p. 211.
|
| corticosteroids |
corticosteroids see Chapter 37.
|
| corticotropin |
corticotropin (adrenocorticotrophic hormone, ACTH) stimulates the cortex of the adrenal glands to produce hormones. The effects produced are similar to, but not identical with, those produced by cortisone. See Chapter 37.
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| cortisone |
cortisone (cortisone acetate, Cortisyl) is a corticosteroid. See Chapter 37.
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| cough and cold preparations |
cough and cold preparations see Chapters 10 and 11.
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| cough suppressants |
cough suppressants see Chapter 11.
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| coumarins |
coumarins are oral anticoagulants. See Chapter 28.
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| Cream E45 |
Cream E45 contains white soft paraffin, light liquid paraffin and wool fat in an emollient base.
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| Creon |
Creon capsules are used to replace enzymes that are lacking due to a deficiency of the pancreas. Each capsule contains pancreatin, containing the enzymes lipase, amylase and protease. Adverse effects include irritation around the anus. Damage to the bowel may occur when high doses are used over a prolonged length of time. Precautions: Drink plenty of fluids. Review patients if abdominal symptoms develop.
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| crisantapase |
crisantapase (Erwinase) is the enzyme asparginase produced by the plant Erwinia chrysanthemi. It is used intramuscularly and subcutaneously to treat acute lymphoblastic anaemia. See Chapter 51 on drugs used to treat cancer. Adverse effects include nausea, vomiting, drowsiness, severe allergic reactions and changes in the blood fat level and liver function tests. Precautions see Chapter 51. Careful monitoring for early signs of adverse effects is necessary. Facilities for the immediate treatment of severe allergic reactions should be to hand.
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| crotamiton |
crotamiton (Eurax, in Eurax Hydrocortisone) is used as a skin application to relieve itching. See p. 216. Precautions: It should be used only on small areas of skin in babies and infants. It should not be used near the eyes or on areas of broken skin. Do not use in patients with acute, weeping eczema.
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| Crystacide cream |
Crystacide cream contains hydrogen peroxide for the treatment of superficial bacterial skin infections.
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| crystal violet |
crystal violet (gentian violet, methyl violet) is a dye used as an antiseptic. See p. 214. It may rarely cause nausea, vomiting, diarrhoea and ulceration of the lining of the mouth. It may stain clothes. Precautions: Keep away from eyes. It may trigger cancer in animals and is not recommended for use on open wounds or in the mouth. It is used to mark out the skin prior to surgery and as an antiseptic on areas of unbroken skin.
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| Cuplex |
Cuplex gel contains salicylic acid, lactic acid and copper acetate. It is used to treat warts and corns. Precautions: Do not use on facial warts or on warts around the anus and/or genitals. Avoid contact with healthy skin and eyes.
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| cyanocobalamin |
cyanocobalamin (Cytacon, Cytamen) is a form of vitamin B12. It is a cobalt-containing substance. It is used to treat anaemias caused by vitamin B12 deficiency. See Chapter 36.
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| cyclophosphamide |
cyclophosphamide (Endoxana) is an anti-cancer drug. See Chapter 51. It is also used as an immunosuppressant to treat rheumatoid arthritis. See p. 143. Adverse effects: It may cause nausea, vomiting and diarrhoea, and occasionally inflammation and bleeding of the bowel, bleeding cystitis, bone-marrow damage producing blood disorders, damage to sperm production and loss of periods. Loss of hair is common but it regrows in two or three months even if the drug is continued. Precautions: It should not be given in pregnancy, to breastfeeding mothers, to patients with an infection of the urinary tract or bleeding from the bladder, or to patients whose bone-marrow function is reduced. It should be used with caution in elderly and/or debilitated patients, and in diabetes. Interactions: Radiotherapy, doxorubicin, sulphonylureas.
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| cycloserine |
cycloserine (Cycloserine) is an antibiotic drug used to treat pulmonary tuberculosis. See Chapter 50. It is a second-choice drug and should be given in combination with other anti-tuberculous drugs in order to prevent resistance developing. Adverse effects include headache, dizziness, drowsiness, twitching, vertigo, depression, mental disturbances, blood disorders, speech difficulties, convulsions and unconsciousness. Allergic skin rashes occasionally occur, blood sugar levels may be reduced and certain tests for liver function altered. Precautions: Cycloserine should not be given to patients with epilepsy, impaired liver function, severely impaired kidney function, porphyria (a hereditary disorder of metabolism), alcohol dependence, severe anxiety or depression or psychotic illness. It should be given with caution to patients with impaired kidney function, in pregnancy, and in breastfeeding mothers. Tests of liver and kidney function should be carried out at regular intervals. Blood levels of the drug should be monitored if kidney function is impaired or the dose greater than 500 mg/day or if signs of toxicity develop. Interactions: Isoniazid, phenytoin.
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| cysteine |
cysteine (l-cysteine, in Cicatrin) is an amino acid which is an essential constituent of the diet to form body proteins.
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| cytarabine |
cytarabine (Cytosar) is an anti-cancer drug (see Chapter 51) used to treat leukaemia. Adverse effects include nausea, vomiting, diarrhoea, ulcers in the mouth, damage to the bone marrow producing blood disorders, liver dysfunction, skin rashes, joint pains, inflammation of the nerves, visual disturbances and loss of hair. Precautions: It should not be given to patients who are pregnant or to breastfeeding mothers. Frequent blood counts, tests of bone-marrow, liver and kidney function should be carried out. It should not be used in patients with impaired kidney or liver function.
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| cytotoxic drugs |
cytotoxic drugs, see Chapter 51 on anti-cancer drugs.
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| dacarbazine |
dacarbazine (DTIC-Dome) is an anti-cancer drug. See Chapter 51. Adverse effects include severe nausea and vomiting, and damage to the bone marrow producing blood disorders. Precautions: It is irritant to the skin and mucous membranes and should therefore be handled with great caution. Dacarbazine is combined with doxorubicin (was named Adriamycin), bleomycin and vinblastine in ABVD treatment of Hodgkin’s disease.
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| daclizumab |
daclizumab (Zenapax) is used to prevent organ rejection in kidney transplants, in conjunction with treatment to suppress the immune system. Adverse effects include allergic reactions. Precautions: Do not use in pregnancy or while breastfeeding.
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| dactinomycin |
dactinomycin (actinomycin D, Cosmegen-Lyovac) is an anti-cancer drug used principally to treat cancers in childhood. It is given intravenously. Adverse effects and Precautions are similar to those listed under doxorubicin except that toxic effects on the heart are not a problem.
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| dalfopristine/quinupristin |
dalfopristine/quinupristin (Synercid) is used to treat Gram-positive infections, including pneumonia, skin or soft tissue infections, when no other option is appropriate and also to treat infections due to E.faecium. See Chapter 46. Adverse effects include injection site reactions, rash, stomach and bowel upsets, headache, itching, pain in joints, pain in muscles, excessive bilirubin in the blood and blood disorders. Precautions: Do not use in patients with kidney or liver damage, in pregnancy or while breastfeeding.
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| Dalivit oral drops |
Dalivit oral drops are a multivitamins preparation containing vitamins A, B group, C and D.
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| danazol |
danazol (Danol) blocks the secretion of gonadotrophins by the pituitary. It is used to treat endometriosis, infertility associated with endometriosis, heavy periods, benign breast disorders, premenstrual syndrome, enlargement of the breasts in males, precocious puberty and other endocrine disorders where control of the release of the pituitary gonadotrophic hormones, luteinising hormone (LH) and follicle stimulating hormone (FSH), may be beneficial. Adverse effects: Masculinization in women, acne, oily skin, mild hirsutism (hairiness), reduction of breast size, menstrual disturbances, flushing, backache, fluid retention, skin rashes, nausea, headache, dizziness, emotional upsets, nervousness, muscle spasms, jaundice, increase in weight and blood, thyroid and circulatory disorders. Precautions: Should not be used in pregnancy, in patients with porphyria (a hereditary disorder of metabolism) or in breastfeeding mothers, in patients with severe liver, heart or kidney disease, thrombotic disease, undiagnosed vaginal bleeding or androgenic-dependent tumours. Avoid sexual intercourse or use mechanical contraceptive while on treatment. Use with caution in patients with epilepsy, migraine, raised blood pressure, heart disease, polythaemia (a blood disorder) or any disorders made worse by fluid retention. Interactions: Anticoagulants, anti-epileptic drugs, corticosteroids, anabolic steroids, ciclosporin, anti-diabetic drugs, anti-blood pressure drugs, anti-migraine drugs, alcohol and alfacalcidol.
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| dantron |
dantron (in Ailax, in codanthrusate, in Codalax, in Danlax, in Normax) is a stimulant laxative. See Chapter 21. Adverse effects include abdominal cramps, nausea, vomiting, malfunctioning of the bowel and a low blood potassium level. The urine may be coloured red and so may the skin around the anus. Precautions: Do not use if bowel is obstructed. Use with utmost caution in pregnancy and breastfeeding mothers. Also see p. 93.
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| dapsone |
dapsone is used to treat leprosy, dermatitis herpetiformis (an inflammatory skin disease), and combined with pyrimethamine (in Maloprim) in preventative treatment for malaria. Adverse effects include nerve damage, loss of appetite, allergic dermatitis, nausea, vomiting, headache, insomnia, rapid heart rate, anaemia, severe mental disturbances (psychoses), weight loss, nerve damage, inflammation of the liver and blood disorders. Precautions: Do not use in patients with porphyria (a hereditary disorder of metabolism) or severe anaemia. Use with caution in patients with heart or lung disease and in breastfeeding mothers, in pregnancy, in anaemia and in patients with G6PD deficiency. Give folic acid supplements in pregnancy. Interactions: Rifampicin, probenecid, PABA.
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| darbepoetin |
darbepoetin (Aranesp) is used for the treatment of anaemia associated with chronic kidney failure. See Chapter 35. Adverse effects include headache, high blood pressure, blood clots, pain at injection site. Precautions: It should not be administered to breastfeeding mothers, caution should be used in pregnancy, in impaired liver function, sickle cell anaemia or epilepsy.
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| De-Noltab |
De-Noltab tablets (tripotassium dicitrato bismuthate) protect the lining of the stomach. They are used to treat peptic ulcers. See Chapter 19. Adverse effects: Blackening of the stools usually occurs and darkening of the tongue may occur. Precautions: It should not be used in patients with kidney impairment or in pregnancy.
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| debrisoquine |
debrisoquine (debrisoquine sulphate) has effects and uses similar to those described under guanethidine. It is used to treat raised blood pressure. See Chapter 25.
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| deferiprone |
deferiprone (Ferriprox) is used to treat iron overload in thalassaemia major (a hereditary defect in the ability to produce haemoglobin) where desferrioxamine is unsuitable. Adverse effects include a decrease in the number of white cells in the blood (neutropenia or agranulocytosis), discolouration of urine, stomach and bowel upsets, increased appetite, arthritis. Precautions: Do not use in patients with a history of recurrent neutropenia or agranulocytosis, in pregnancy or while breastfeeding. Use with caution in patients with kidney or liver damage or scarring of the liver. Signs of infection should be reported immediately.
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| deflazacort |
deflazacort (Calcort) is a corticosteroid used to treat severe asthma, rheumatoid arthritis and other inflammatory reactions. See Chapter 37. Adverse effects include suppression of growth in children, high blood pressure, sodium retention, stomach and bowel disorders, water retention, potassium loss, muscle weakness, death of tissue cells at the joints of the thighbone and upper arm-bone, cushingoid changes (after taking corticosteroids the patient may have the appearance of having Cushing’s syndrome – a fat face and body), hyperglycaemia, osteoporosis, depression, euphoria, peptic ulcers. Precautions: Do not use in patients with infections unless undergoing antibiotic treatment. Use with caution in patients with tuberculosis, infections, amoebic infection, stomach and bowel upsets. Avoid contact with chicken pox or measles.
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| Delfen |
Delfen is a spermicidal contraceptive foam which contains nonoxinol 9.
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| demeclocycline |
demeclocycline (demeclocycline hydrochloride, demethylchlortetracycline hydrochloride, in Deteclo, Ledermycin) is a tetracycline antibiotic (see p. 237). It is long-acting. Adverse effects and Precautions: These are similar to those described under tetracyclines but there is an increased risk of skin sensitivity to sunlight. Patients should therefore avoid exposure to sunlight when receiving treatment. It is used by mouth to treat severe acne (see p. 219) and general infections.
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| demulcent cough preparations |
demulcent cough preparations see Chapter 11.
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| Dentinox Colic Drops |
Dentinox Colic Drops contain activated dimethicone which is used to treat gripe, colic or wind pains.
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| dequalinium |
dequalinium (dequalinium chloride, Dequadin, Labosept) is an antiseptic (see p. 214) used in throat lozenges and paints. Precautions: Its prolonged and repeated use should be avoided. It can cause the skin to become inflamed when applied under dressings and it should not be used around the anus and genitals.
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| Dermalo |
Dermalo is a bath emollient (skin softener) which contains acetlyated wool alcohols and liquid paraffin.
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| Dermol lotion |
Dermol lotion contains benzalkonium chloride, chlorhexidine hydrochloride, liquid paraffin and isopropyl myristate. It is used to soften dry skin.
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| desferrioxamine |
desferrioxamine (Desferal) is used in the treatment of iron poisoning and in patients who store too much iron in their bodies. It joins with the iron, and the combination is excreted in the urine. It is also used to treat aluminium overload in patients receiving kidney dialysis. Adverse effects include pain at the site of injection, and a drop in blood pressure, flushing and shock if given too rapidly by IV injection. Fever, stomach and bowel upsets, red urine, allergic skin rashes. Leg cramps and rapid beating of the heart may, rarely, occur. Very rarely, cataract, and disturbances of vision and hearing, slowing of growth, impaired kidney and liver function, blood disorders and nerve damage may occur. Precautions: Use with caution in patients with impaired kidney function, in pregnancy and in breastfeeding mothers. Regular eye and hearing tests should be carried out while on treatment. May cause fits in patients with brain malfunction due to overload with aluminium, therefore pre-treat these patients with the anti-epileptic drug clonazepam. Stop treatment if patient develops an infection and do not start again until the infection has cleared up. Monitor heart function in patients taking vitamin C. Measure height and weight in children every three months. Interactions: Prochlorperazine, erythropoietin, vitamin C, gallium scintigraphy.
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| desflurane |
desflurane (Suprane) is a rapidly acting liquid anaesthetic. See Chapter 44. It is not recommended for use in children.
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| desirudin |
desirudin (Revasc) is used for the prevention of deep vein thrombosis (blood clots) in elective hip and knee replacement surgery. See Chapter 28. Adverse effects include bleeding, nausea, weeping from wounds, fever, injection site reactions, blood clots, anaemia, low blood pressure, urinary retention, thrombophlebitis (inflammation of a vein), high fever, allergic reactions. Precautions: Do not use in active bleeding or irreversible blood disorders, severe kidney or liver damage, severe uncontrolled high blood pressure, subacute bacterial endocarditis (inflammation of the lining membrane of the heart), in pregnancy or while breastfeeding. Use with caution in patients with mild liver or kidney damage, damage to the retina due to diabetes which is not being controlled, a history of stroke, a tendency to haemorrhage.
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| desloratidine |
desloratidine (Neoclarityn) is an antihistamine used to treat hayfever. See Chapter 17. Adverse effects include headache. Precautions: Do not use in patients with an allergy to loratadine or who are breastfeeding. Use with caution in patients with severe kidney damage or in pregnancy.
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| desloughing applications |
desloughing applications are used to remove slough, clots and debris from infected wounds and ulcers. Preparations include Aserbine cream (contains propylene glycol and benzoic, malic and salicylic acids), Hioxyl cream (contains hydrogen peroxide) and Varidase (contains the protein-dissolving enzyme streptokinase). Preparations that help to remove secretions also include adsorbent applications.
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| desmopressin |
desmopressin (in DDAVP nasal drops, tablets and injections, Desmotabs tablets, Desmospray nasal spray, Nocutil) is a synthetic relative of the natural anti-diuretic hormone vasopressin (AVP), which is a hormone produced by the posterior pituitary gland. This hormone causes the kidneys to retain water from the urine. Desmopressin is used to treat diabetes insipidus – a condition in which the posterior lobe of the pituitary gland fails to produce the anti-diuretic hormone with the result that the patient drinks excessive amounts of fluids and passes large volumes of weak urine. Desmopressin is also used to treat bed-wetting (see p. 250) and to test kidney function. Adverse effects include headache, stomach pains, nausea and a low blood sodium level which may trigger convulsions. Precautions: It should be used with caution in patients with impaired kidney function, cystic fibrosis, or heart disease and in pregnancy. Avoid fluid overload. Use with caution in asthma, epilepsy, migraine or any disorder that may be made worse by fluid retention. Exclude alcohol abuse or psychological over-drinking of fluids before starting treatment. It should only be used to treat bed-wetting in patients who have a normal blood pressure. Interactions: Indomethacin, tricyclic antidepressants, chlorpromazine, carbamazepine. |
| desoxymetasone |
desoxymetasone (desoxymethasone, in Stiedex preparations) is a topical corticosteroid used to treat skin disorders. Adverse effects and Precautions see corticosteroid skin applications p. 211.
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| Dettol |
Dettol preparations contain chloroxylenol. See p. 215.
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| dexamethasone |
dexamethasone is a corticosteroid. See Chapter 37. It is used orally (Decadron, Dexol) to treat rheumatic, allergic and inflammatory disorders. Adverse effects and Precautions see Chapter 37 on corticosteroids. Dexamethasone is included in Dexa-Rhinaspray-Duo used to treat hay-fever (see p. 74. It is used in Maxidex, Maxitrol, in Sofradex and in Tobradex eye drops used to treat inflamed eyes. Adverse effects of eye drops include a rise in pressure inside the eye, thinning of the cornea, cataract and fungal infections. Precautions: Do not use in patients with glaucoma, or a viral, fungal, tuberculous or infection of the eyes. Do not wear soft contact lenses. Dexamethasone is also used to treat eczema of the ear (otitis externa) in Otomize ear spray and in Sofradex ear drops. Ear preparations should not be used if the ear drum is perforated and they should be used with caution in pregnancy. Long-term use in infants should be avoided.
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| dexketoprofen |
dexketoprofen (Keral) is a non-steroidal anti-inflammatory drug used to treat musculoskeletal pain, difficult or painful menstruation and dental pain. See Chapter 32. Adverse effects include stomach and bowel upsets, headache, dizziness, blood disorders. Precautions: Do not use in patients with an allergy to aspirin or anti-inflammatory drugs, asthma, severe kidney or liver damage, active or history of recurrent peptic ulcer, chronic indigestion, bleeding disorders, inflammation of the bowel, severe heart failure, in pregnancy or while breastfeeding. Use with caution in patients with a history of bronchial asthma or allergic disease, systemic lupus erythematosis (SLE – a disease of unknown cause with symptoms of fever, muscle and joint pain, blood disorders and skin eruptions), heart disease, mild liver or kidney damage or in the elderly.
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| dextranomer |
dextranomer (Debrisan powder and paste) cleans wounds and ulcers by absorbing secretions. It is prepared from dextran. It should not be used on deep wounds or cavities (because it may be difficult to remove) and it should not be used on dry wounds or near the eye.
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| dextromethorphan |
dextromethorphan (dextromethorphan hydrobromide) is a cough suppressant included in several cough medicines. See Chapter 11. Adverse effects: It may occasionally cause drowsiness and dizziness.
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| dextromoramide |
dextromoramide (dextromoramide tartrate, Palfium) is an opiate pain-reliever. See Chapter 30. It is used to relieve moderate to severe pain. It may be given by mouth, by rectum or by sub-cutaneous or intramuscular injection. It works for about four hours. Adverse effects: Dextromoramide may cause nausea, vomiting, sweating, dizziness, faintness (due to a fall in blood pressure) and insomnia. As with morphine, these are more likely to occur if the patient is up and about. Precautions: It should be used with caution in patients with impaired liver function. It is a powerful respiratory depressant and should not be used in women in labour. It should not be used in patients whose breathing is depressed or who have chronic obstructive airways disease. It should be used with caution in pregnancy, in the elderly and in patients with underworking of their thyroid gland. Interactions: MAOIs, anaesthetics, sedatives, hypnotics and tranquillizers. After each of the first few doses the patient should lie down for half an hour because of the drug’s effects. Drug dependence: Regular daily use may lead to tolerance, mood changes and drug dependence of the morphine type.
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| dextropropoxyphene |
dextropropoxyphene (in co-proxamol, in Cosalgesic, in Distalgesic, Doloxene, in Doloxene Compound) is an opiate (opioid) pain-reliever. See Chapter 30. Adverse effects: Dextropropoxyphene may cause dizziness, headache, dry mouth, blurred vision, drowsiness, excitation, raised mood (euphoria), insomnia, skin rashes, nausea, vomiting, abdominal pains and constipation. Precautions: Dextropropoxyphene should be given with caution to patients with severe respiratory disorders, impaired liver or kidney function, and in pregnancy. Regular daily use may lead to tolerance and drug dependence of the morphine type. Interactions: MAOIs, alcohol, sedatives, sleeping drugs and other drugs that depress brain function.
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| Dianette tablets |
Dianette tablets contain the anti-male sex hormone cyproterone and the female oestrogen sex hormone ethinyloestradiol. They are used to treat severe acne in females, see p. 219. The reason for using it is to try to block the effects of male sex hormones (androgens) which are considered to be a major factor in the development of acne. Dianette is also an effective oral contraceptive and women should not take any other oral contraceptive while on this treatment. They are not suitable for treating male acne. It may also be used to treat severe hirsutism (excessive hair growth). Adverse effects: Breast enlargement, bloated feeling, fluid retention, cramps, pains in the legs, depression, loss of libido, headaches, nausea, vaginal discharge, superficial ulcers on the neck of the womb, weight gain, breakthrough bleeding and brown patches on the skin of the face (chloasma). Precautions: Do not use in pregnancy or in patients who suffer from or who have suffered from angina, coronary heart disease, blood clots, valvular disease of the heart, sickle cell anaemia, jaundice, hepatitis (inflammation of the liver), liver disease or any other disorder in which an oral contraceptive should not be taken. It should be used with caution in patients with hypertension, Raynaud’s disease, diabetes, varicose veins, asthma or severe depression, or in patients receiving kidney dialysis. For other precautions see Chapter 41 on oral contraceptives.
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| diazoxide |
diazoxide (Eudemine) is a vasodilator drug used to treat a severe rise in blood pressure (see Chapter 25), particularly if associated with kidney disease. It is also used to treat low blood sugar (hypoglycaemia) (see Chapter 42). Adverse effects include rapid beating of the heart, raised blood sugar level, fluid and salt retention, fall in blood pressure on standing up after sitting or lying down (postural hypotension), coma and delayed labour. Precautions: Use with caution in patients with severe impairment of kidney, brains or heart function, low blood protein levels, in pregnancy or in labour. Blood sugar levels should be checked at regular intervals. Interactions: Diuretics, anti-blood pressure drugs, coumarin anticoagulants.
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| dibrompropamidine |
dibrompropamidine (isethionate, Brolene, Golden Eye Ointment) is an antibacterial drug used to treat bacterial infections of the eyelids and conjunctiva. It is also used to treat amoebic infections of the cornea (acanthamoeba keratitis).
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| dicobalt edetate |
dicobalt edetate (Kelocyanor) is given by intravenous injection to treat acute cyanide poisoning. Because of its toxicity it should only be used if patient has lost or is losing consciousness. Adverse effects include fall in blood pressure, rapid heart beat and vomiting.
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| didanosine |
didanosine (DDI, Videx) is an antiviral drug used to treat patients suffering from HIV infection. See Chapter 48. Adverse effects include nausea, vomiting, diarrhoea, confusion, rash, itching, insomnia, weakness, damage to the pancreas, raised blood uric acid levels, convulsions, nerve damage and pneumonia, eye damage, blood disorders and rarely liver damage. Precautions: Do not use in patients in whom the drug has previously caused liver damage. Use with utmost caution in patients with a history of inflammation of the pancreas, nerve damage, a raised blood uric acid level, or impaired liver or kidney function. Use with utmost caution in pregnancy and breastfeeding mothers and do not take the drug at the same time as a tetracycline antibiotic because the tablets contain aluminium and magnesium antacids which can interfere with the absorption of tetracyclines. Liver function, blood fats and uric acid blood levels should be monitored at regular intervals. Check for evidence of nerve damage. Monitor serum amylase before and at regular intervals during treatment. Check the eyes in children for retinal changes. Use with caution in patients with phenylketonurea and patients on a low-sodium diet. Interactions: Tetracyclines (see above), drugs that affect or are affected by the acid in the stomach, ganciclovir and drugs known to damage nerves or the pancreas.
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| diethyltoluamide |
diethyltoluamide is an insect repellent. It can occasionally cause allergic reactions. It should not be applied near the eyes, to mucous membranes, to broken skin or near areas of skin flexion (e.g. elbows) – it can cause irritation and blistering.
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| diflucortolone |
diflucortolone (diflucortolone valerate, Nerisone) is a potent corticosteroid used in skin applications. Adverse effects and Precautions see corticosteroid skin applications p. 211. It is used to treat severe eczema and psoriasis.
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| Diftavax |
Diftavax is absorbed Diptheria and Tetanus vaccine for adults and adolescents.
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| Digibind |
Digibind infusion contains digoxin-specific antibody fragments. It is used to treat digoxin and digitoxin overdosage. Adverse effects include fall in blood potassium levels. Precautions: Do not use in patients allergic to ovine protein.
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| digoxin |
digoxin (Lanoxin) is used to treat heart failure and disorders of heart rhythm. See Chapter 23. Adverse effects include nausea, loss of appetite, vomiting, diarrhoea, abdominal pain, visual disturbances, fatigue, drowsiness, headache, confusion, delirium, hallucinations, slowing of heart rate and heart block. These adverse effects are usually associated with overdosage. Precautions: Do not use in patients with heart block or certain disorders of the heart or heart rhythm. Use with caution in patients who have had a recent heart attack and in patients with an over-active thyroid gland or impaired kidney function. Reduce the dose in the elderly and avoid rapid intravenous infusion because it may cause nausea, vomiting and disorders of heart rhythm. Use with caution in patients with severe lung disease or raised blood calcium levels. Monitor heart rate, ECG and blood chemistry. Interactions: Calcium supplements, digoxin-related drugs, any drug that may cause a fall in blood potassium levels, quinidine, lithium, antacids, antibiotics.
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| dihydrotachysterol |
dihydrotachysterol (AT 10) is related to vitamin D. It is used to treat tetany (spasm or cramps due to disturbed blood chemistry) caused by a low blood calcium level due to underworking of the parathyroid glands Adverse effects: It may cause a rise in blood calcium levels and calcium in the urine, loss of appetite, listlessness, thirst, vertigo, headache, nausea, urgency to pass urine, passing large volumes of urine, paralysis, stupor. Precautions: Use with caution in pregnancy, in breastfeeding mothers or if kidney function is impaired. Monitor blood calcium levels. Interactions: Thiazide diuretics, digoxin and related drugs, cholestyramine.
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| dihydroxycholecalciferol |
dihydroxycholecalciferol is a form of vitamin D. See Chapter 36 on vitamins.
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| Dijex |
Dijex is an antacid preparation containing aluminium and magnesium.
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| diloxanide furoate |
diloxanide furoate (Furamide is used to treat chronic amoebic infections of the intestine. Adverse effects include wind, vomiting, itching and nettle-rash. Precautions: Use with utmost caution in pregnancy and in breastfeeding mothers.
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| diltiazem |
diltiazem (Adizem, Angitil, Angitil SR, Angiozem, Calcicord CR, Dilcardia SR, Dilzem, Optil SR, Optil XL, Slozem, Tildiem, Viazem XL, Zemtard XL) is a calcium channel-blocker used to treat angina (see Chapter 22) and hypertension (see Chapter 25). Adverse effects include slowing of the heart, heart block, fluid retention causing ankle swelling, headache, nausea, rashes, fall in blood pressure, generally feeling unwell, hot flushes, stomach and bowel upsets. Depression and liver damage have been reported. Precautions: Do not use in patients with severe slowing of the heart rate, left ventricular failure, serious heart block, or in pregnancy. Use with caution in patients with impaired liver or kidney function, heart failure, or mild slowing of the heart rate. Interactions: Other anti-blood pressure drugs, beta-blockers, digoxin, carbamazepine, cyclosporin, theophylline, cimetidine, lithium.
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| dimencaprol |
dimencaprol (BAL, Dimercaprol) is used to treat poisoning by antimony, arsenic, bismuth, gold, mercury and thallium. It is used with sodium calcium edetate to treat lead poisoning. Adverse effects include nausea, vomiting, salivation, runny eyes, sweating, rapid heart beat, raised blood pressure, burning sensation in mouth, throat and eyes, tightness of throat and chest, abdominal pain, headaches, muscle spasms and tingling in the hands and feet. It may cause a fever in children and the injection may cause local pain and abscesses. Precautions: Do not use to treat iron, cadmium or selenium poisoning and do not use to treat severe liver involvement unless due to lead. Use with caution in pregnancy, in the elderly and in patients with raised blood pressure and impaired kidney function. Be very cautious if impaired kidney function develops during treatment.
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| dimethicones |
dimethicones (in Conotrane, in Kolanticon, in Siopel, in Sprilon, in Timodine, in Vasogen) are water-repellent silicones used to reduce wind when taken by mouth (they work as anti-foaming agents). They are also used in barrier skin applications as a water-repellent.
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| dimethyl sulfoxide |
dimethyl sulfoxide (dimethyl sulphoxide, methyl sulphoxide, in Herpid, in Rimso-50) is principally used as a basis for other drugs to be applied to the skin. It increases their effects by aiding their penetration into the skin. It is well absorbed into the blood-stream, broken down in the body to dimethyl sulphide, and excreted in the urine, faeces, breath and skin, which produces a characteristic garlic-like odour in anyone using it. Adverse effects: High concentrations applied to the skin may cause a burning sensation, itching, redness and very rarely, blisters. Long-term use may cause nausea, vomiting, abdominal cramps, chest pains, headache, drowsiness and allergic reactions.
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| dinoprostone |
dinoprostone is prostaglandin E2. See Chapter 52. It causes the uterus to contract and the cervix to soften and is used to start off labour or to produce an abortion. Preparations include Prepidil (cervical gel), Propess-RS (vaginal pessaries) and Prostin E2 (tablets, intravenous solution, extra-amniotic solution, vaginal gel and vaginal tablets). Adverse effects include nausea, vomiting, diarrhoea, severe contractions of the uterus. Intravenous administration may cause flushing, shivering, dizziness, headache, transient rise in temperature and raised white blood cell count. Intravenous injections may cause pain and redness at site of injection and there is a risk of infection with extra-amniotic injection. Precautions: Do not use in women allergic to prostaglandins, who have ruptured membranes, history of Caesarean section or major surgery on the uterus. Do not use if the baby is in the wrong position, in women with untreated pelvic infections, if the baby is distressed, in a multiple pregnancy, in women who have had many babies or a history of difficult childbirth. Do not use extra-amniotic route if patient has an infection of her vagina or cervix. Use with caution in patients with asthma or glaucoma. Monitor activity of uterus and monitor the baby. Interactions: oxytocin.
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| Diocalm |
Diocalm is an antidiarrhoeal preparation containing attapulgite and morphine.
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| Dioralyte |
Dioralyte powders contain sodium chloride, potassium chloride, sodium acid citrate and glucose. They are used to treat fluid and salt loss, especially in babies with diarrhoea and vomiting. See Chapter 20.
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| diphenylbutylpiperidines |
diphenylbutylpiperidines (antipsychotic drugs) see p. 52.
|
| dipivefrine |
dipivefrine (Propine) is a sympathomimetic drug used in eye drops to treat chronic open-angle glaucoma, see p. 53. It is a pro-drug of adrenaline which passes rapidly through the cornea to release the adrenaline(epinephrine) inside the front chamber of the eye. Adverse effects include transient stinging of the eyes and rebound redness. It may occasionally cause allergic reactions and, very rarely, a raised blood pressure. Precautions: Do not use in patients with closed-angle glaucoma. Do not wear soft contact lenses. Use with caution in patients with narrow-angle glaucoma or aphakia (missing a lens in the eye).
|
| dipyridamole |
dipyridamole (in Asasartin Retard, Persantin) is an anti-platelet drug (see p. 123) used with anti-coagulants to prevent blood clots around prosthetic heart valves. Adverse effects: It may cause headache, dizziness, faintness, rash and stomach and bowel upsets. Precautions: It should be used with caution in patients with rapidly worsening angina or narrowing of the main artery from the heart (aortic stenosis). Interactions: Antacids.
|
| disinfectants |
disinfectants see p. 214.
|
| disodium folinate |
disodium folinate (Sodiofolin) is used to enhance the effects of the anti-cancer drug 5-fluorouracil (5FU) in bowel cancer. See Chapter 51. Adverse effects include allergic reactions, fever. Precautions: Do not use in pregnancy or while breastfeeding.
|
| disodium pamidronate |
disodium pamidronate (Aredia) is used to treat raised blood calcium levels caused by secondary cancer deposits in bone, bone loss and bone pain associated with secondary breast cancer, multiple myeloma and Paget’s disease of the bone. Adverse effects include nausea, diarrhoea, a mild transient rise in temperature, flu-like symptoms, bone, joint and muscle pains, eye disorders (iritis, uveitis), skin reactions at the site of injection, headache, blood disorders and low blood magnesium and calcium levels. Precautions: Do not use in patients known to be allergic to the drug. Use with utmost caution in pregnancy, in breastfeeding mothers, in patients with impaired kidney function, heart disease or previous thyroid surgery. Changes in blood chemistry may possibly trigger convulsions. Monitor blood chemistry and kidney function during long-term use. Inter-actions: Biphosphonates used to lower blood calcium level, plicamycin.
|
| disopyramide |
disopyramide (disopyramide phosphate, Dirythmin SA, Isomide CR, Rythmodan, Rythmodan Retard) is used to treat disorders of heart rhythm (see Chapter 24). Adverse effects: Dry mouth, blurred vision, difficulty in passing water, constipation, stomach and bowel upsets, low blood pressure, low blood sugar levels, low blood potassium levels and disorders of heart rhythm. Precautions: Do not use in patients with serious heart block (in absence of a pacemaker), cardiomyopathy (disease of the heart muscles), low blood pressure, or severe collapse due to a heart attack. It should be used with caution in patients with a low blood potassium, with glaucoma, enlarged prostate gland, a tendency to retention of urine, mild heart block, heart failure (should be controlled with digoxin), impaired kidney or liver function, in pregnancy or in patients with myasthenia gravis (muscle weakness due to neuromuscular abnormality). Interactions: Other class I anti-arrhythmic drugs, beta-blockers, drugs that lower blood potassium levels, antimuscarinics, erythromycin, rifampicin, phenytoin.
|
| disulfiram |
disulfiram (Antabuse) is used to treat alcoholism. It is not a cure and it is used because it produces unpleasant effects when alcohol is taken. These unpleasant effects are caused by an accumulation in the blood of a breakdown product of alcohol called acetaldehyde. Within fifteen minutes of taking alcohol, disulfiram may produce red eyes, flushed face, throbbing headache, fast-beating heart, dizziness, nausea, sweating and vomiting. An irritation in the throat, deep breathing and a fall in blood pressure, collapse and convulsions may occur. The effects last from a half to one hour in mild cases and up to several hours in severe attacks. The intensity and duration vary greatly between individuals; initial treatment should therefore only be used in hospital. A careful dosage regimen needs to be worked out, starting with a high dose and slowly working down to a maintenance dose. Adverse effects: Disulfiram may cause indigestion, bad breath, body odour, nausea, vomiting, drowsiness, fatigue, severe mental symptoms, liver damage, headache, impotence, allergic skin rashes and nerve damage (peripheral neuritis). Even small quantities of alcohol (e.g. in oral medicines) may produce a severe reaction. Precautions: Do not take alcohol for at least twelve hours before starting disulfiram. It should not be used in pregnancy, in patients with heart disease, raised blood pressure, history of a stroke, with severe psychological disorders or with drug dependence. It should be used with the utmost caution in patients with impaired liver or kidney function, and in patients with epilepsy, chronic chest disorders or diabetes. Interactions: alcohol, barbiturates, warfarin, paraldehyde. Toiletries containing alcohol should be avoided.
|
| dithranol |
dithranol (Dithrocream, Micanol, in Psorin) is used to treat psoriasis. Some patients are sensitive to it and a small area of skin should be tested first. It stains the skin, causes a burning sensation and irritates the eyes. Do not use to treat acute psoriasis. Avoid contact with unaffected skin, eyes and mucous membranes.
|
| diuretics |
diuretics see Chapter 29.
|
| dobutamine |
dobutamine (Dobutrex, Posiject) is a beta-stimulant sympathomimetic drug used to stimulate the heart (see p. 107) in patients whose circulation has collapsed due to sudden heart failure (cardiogenic shock), septic shock or during heart surgery. Adverse effects include rapid beating of the heart. A marked rise in systolic blood pressure indicates overdose. Precautions: Use with caution in patients with cardiogenic shock whose blood pressure is seriously low.
|
| docetaxel |
docetaxel (Taxotere) is an anti-cancer drug (see Chapter 51) to treat patients suffering from advanced breast cancer. Adverse effects include fall in white blood cell and platelet counts, increased risk of bleeding, anaemia, allergic reactions, fall in blood pressure, wheezing, skin rashes, loss of hair, damage to nails, fluid retention, nerve damage, painful joints and muscles, inflammation of the lining of the mouth and intestine and changes in liver function tests. Precautions: Monitor blood counts and liver function. During infusions watch out for allergic reactions and fluid retention. Interactions: Cyclosporin, terfenadine, ketoconazole, erythromycin, troleandomycin.
|
| docusate sodium |
docusate sodium (in co-danthrusate, in Capsuvac, Dioctyl, Docusol, in Fletcher’s Enemette, Molcer ear drops, Norgalax micro-enema, in Normax, Waxsol ear drops) is a surface-active agent which lowers surface tension and has detergent properties. It is used as a laxative (see p. 94), to soften wax in the ears (see p. 47), to make tablets disintegrate in the body and as a surface-active agent in industry.
|
| domiphen |
domiphen (in Bradosol Plus), is an antiseptic with properties similar to those described under cetrimide. It is used in throat lozenges and antiseptic skin applications. In higher concentration it may be used as a disinfectant.
|
| domperidone |
domperidone (in Domperamol, Motilium) is an anti-dopamine drug used to treat acute nausea and vomiting caused by disorders of the stomach or intestine or by anti-cancer drugs, radiotherapy or anti-parkinsonism drugs (levodopa, bromocriptine). See Chapter 18. It may also be used to treat indigestion. Adverse effects: It has similar effects to metoclopramide but is less likely to cause sedation and atony (lack of muscle tone). It may send up the level of prolactin in the blood and cause enlargement of the breasts and milk production. It may cause allergic reactions, skin rashes, reduced libido and acute disorders of movement (dystonias). Injections may cause serious disorders of heart rhythm in patients with heart disease or low blood potassium levels. Precautions: Do not use regularly every day, or as a routine following surgery. Do not use in pregnancy. Use with caution in patients with impaired kidney function and in breastfeeding mothers.
|
| donepezil |
donepezil (Aricept) is an acetylcholinesterase inhibitor used to treat mild to moderately severe Alzheimer's dementia. See Chapter 9. Adverse effects include stomach and bowel upsets, muscle cramps, fatigue, insomnia, dizziness, headache, pain. Rarely, liver damage, psychiatric disturbances, fainting, slow heart beat, seizures, liver dysfunction, loss of appetite, anorexia, stomach and bowel ulcers and haemorrhage, muscle dysfunction. Precautions: Do not use in pregnancy or while breastfeeding. Use with caution in patients with altered heart beat, history or risk of stomach or bowel ulcers, asthma, severe difficulty breathing, bladder outflow obstruction, seizures, muscle dysfunction.
|
| dopa-decarboxylase inhibitors |
dopa-decarboxylase inhibitors see p. 67.
|
| dopamine |
dopamine is a sympathomimetic drug (see Chapter 9) used to treat patients whose circulation has collapsed due to sudden heart failure (cardiogenic shock) as a result of a heart attack or during heart surgery, see p. 107. Adverse effects include nausea, vomiting, rapid beating of the heart, changes in blood pressure, and coldness and paleness of the skin (vasoconstriction). Precautions: Do not use in patients with a tumour of the central nervous system or a rapid heart beat. Any reduction in blood volume must be treated immediately with intravenous blood or fluids. The dose of dopamine must be carefully controlled; low doses may cause dilatation of arteries and increase the flow of blood through the kidneys, whereas high doses may cause constriction of arteries and make the heart failure worse.
|
| dopexamine |
dopexamine (Dopacard) is used to treat heart failure (see p. 107) during heart surgery. It is a sympathomimetic drug that stimulates beta2-receptors and dopamine receptors. It also blocks the re-uptake of noradrenaline(norepinephrine) into nerve cells (see Chapter 9). These actions increase the output from the heart by reducing the afterload, by a direct effect on the heart and by reducing pre-load. Adverse effects include rapid beating of the heart and extra beats during infusion. Occasionally, high doses may cause nausea, vomiting, tremor and anginal pain. Precautions: Do not use in pregnancy or in breastfeeding mothers. Do not use in patients with a tumour of the central nervous system, low platelet count, or obstruction to the outflow of the blood from the heart (e.g. aortic stenosis). Use with caution in patients with acute heart attack, recent anginal attacks, low blood potassium, or high blood sugar.
|
| dornase alfa |
dornase alfa (Pulmozyme) is a genetically engineered version of a naturally occurring human enzyme that helps to breakdown and remove the sticky secretions that build up in the lungs in patients suffering from cystic fibrosis. The solution is given by inhalation through a jetnebulizer. Adverse effects include sore throat, hoarseness, skin rash and voice changes. Precautions: Use with utmost caution in pregnancy or breastfeeding mothers. Do not mix other drugs in the nebulizer.
|
| dorzolamide |
dorzolamide (in Cosopt, Trusopt) eye drops are used to treat raised pressure in the eyes in open-angle glaucoma. See p. 53. It may be used with beta-blockers or in place of beta-blockers if these are unsuitable. They are a carbonic anhydrase inhibitor diuretic. See Chapter 29. Adverse effects include irritation, burning and stinging of the eyes, blurred vision, headache, bitter taste, soreness of the eyelids and conjunctivitis. Precautions: Do not use in patients with severe impairment of kidney function, in pregnancy, or in breastfeeding mothers. Do not wear soft contact lenses. Use with caution in patients with impaired liver function, closed-angle glaucoma or allergy to sulphonamide drugs.
|
| Doublebase |
Doublebase is a skin softening cream containing isopropyl myristate and liquid paraffin.
|
| doxapram |
doxapram (doxapram hydrochloride, Dopram) is given by intravenous infusion to stimulate breathing in patients with respiratory failure. Adverse effects: Rise in blood pressure and heart rate, dizziness and perineal warmth. Precautions: Do not use in patients with very high blood pressure, uncontrolled short-term severe asthma (status asthmaticus), coronary artery disease, or overworking of the thyroid gland. Use with caution in patients with epilepsy or impaired liver function.
|
| doxazosin |
doxazosin (Cardura) is a selective alpha-blocker used to treat raised blood pressure, (see Chapter 25). It is also used to improve passing of urine in patients with an enlarged prostate gland, see p. 251. Adverse effects: A fall in blood pressure may occur on standing up after sitting or lying down (postural hypotension). This may cause light-headedness and faintness. It may also cause headache, fatigue and weakness, dizziness, runny nose, sleepiness and vertigo. Rarely it may cause incontinence of urine. Fluid retention (oedema) may occur, causing, for example, ankle swelling. Precautions: It should not be used by breastfeeding mothers and it should be used with caution in pregnancy. Sleepiness may affect ability to drive.
|
| doxorubicin |
doxorubicin (has replaced adriamycin) (Caelyx, Myocet) is an anti-cancer drug, (see Chapter 51). Adverse effects: It colours the urine red. Doxorubicin may damage the bone marrow causing blood disorders, and it may cause ulcers of the mouth, loss of hair, nausea, vomiting and diarrhoea and, very rarely, allergic reactions and damage to the heart. It may damage the tissues at the site of injection. Precautions: Careful monitoring of the blood and heart should be carried out. It should be used with the utmost caution in patients with impaired heart function and in the elderly.
|
| Duragel |
Duragel is a spermicidal gel containing nonoxinol 9.
|
| dusting powders |
dusting powders are finely divided powders that contain one or more active ingredients. They are applied to skin folds where friction may occur. They should not be applied to areas that are very moist because they may cake and make the skin sore. Talc acts as a lubricant powder but it does not absorb moisture, whereas starch is less lubricant but does absorb water. Other inert powders such as zinc oxide and kaolin may also be used.
|
| E45 cream |
E45 cream contains light liquid paraffin, white soft paraffin and hypoallergenic anhydrous lanolin. It is used to soften the skin. See p. 207.
|
| ear |
ear preparations see Chapter 13. |
| econazole |
econazole (in Econacort, Ecostatin, Gyno-Pevaryl, Pevaryl) is an antifungal drug (see Chapter 47) with some anti-bacterial activity. It is applied onto the skin to treat fungal infections of the skin, thrush of the vagina and nappy rash infected with thrush. It may occasionally cause irritation at the site of application and rarely, an allergic reaction.
|
| efavirenz |
efavirenz (Sustiva) is used in combination with other antiretrovirals to treat HIV-1 infection. See Chapter 48. Adverse effects include skin rash, nervous system reactions such as dizziness, insomnia, impaired concentration, psychotic reactions, stomach and bowel upsets, headache, fatigue, raised liver enzymes. Precautions: Do not use in patients with severe liver damage, in pregnancy or while breastfeeding. Use with caution in patients with mild liver or severe kidney damage, hepatitis B or C, a history of mental illness or substance abuse. |
| Effercitrate |
Effercitrate tablets contain citric acid and potassium bicarbonate. They are used to make the urine less acid (i.e. alkaline) in order to reduce the symptoms of cystitis. Adverse effects include a rise in blood potassium levels, irritation of the stomach and passing more urine than usual. Precautions: Do not use in patients with ulceration or obstruction of the bowel. Use with caution in patients with impaired kidney function. Interactions: potassium-sparing diuretics.
|
| Effico |
Effico is a tonic which contains thiamine, nicotinamide, caffeine and compound gentian infusion.
|
| eicosapentaenoic acid |
eicosapentaenoic acid (Maxepa) is used to treat high triglyceride levels in patients at risk from heart disease (see Chapter 26) or inflammation of the pancreas. Adverse effects include nausea and belching. Precautions: Do not use in patients with bleeding disorders or non-insulin dependent diabetes.
|
| Electrolade |
Electrolade sachets contain a powder for dissolving in cool drinking water for the treatment of fluid loss caused by, for example, diarrhoea and vomiting. The powder in each sachet contains sodium chloride, potassium chloride, sodium bicarbonate and glucose. Precautions: The made-up solution should not be used in patients with kidney failure and used with caution in patients with severe, acute abdominal pain. Diabetic patients should note the sugar content.
|
| Elliman’s Universal Embrocation |
Elliman’s Universal Embrocation is used as a heat rub in muscle pain. It contains acetic acid and turpentine oil.
|
| emedastine |
emedastine (Emadine) anti-allergy eye drops are used to treat inflammation of the eye caused by hayfever. See Chapter 13. Adverse effects include transient stinging in the eye, blurred vision, swelling in the eyes (oedema), headache, inflammation of the lining of the nose and pain. Precautions: Do not use in patients with kidney or liver damage, in the elderly, in pregnancy or while breastfeeding. Use with caution in patients with eye damage. Do not insert contact lenses until 10-15 minutes after using the eye drops. |
| emetics |
emetics are drugs that cause vomiting. Ipecacuanha mixture is occasionally used to empty the stomach after swallowing certain poisons (e.g. salicylates). The chief danger is that some of the vomit from the stomach may be inhaled. There is no evidence that it prevents the absorption of significant amounts of poisons. It must only be used in patients who are fully conscious. It must not be used in patients who have swallowed a corrosive poison or a substance derived from petrol because if these are inhaled they can seriously damage the lungs. It must not be used if the poison is known to produce rapid onset of coma or convulsions. Salt solution, copper sulphate and mustard are dangerous and should not be used to produce vomiting.
|
| EMLA |
EMLA cream contains the local anaesthetics lidocaine(lignocaine) and prilocaine. It is used as an anaesthetic on the skin and genitals. See Chapter 44. May cause transient reactions at the site of application. Do not apply to wounds or to patients with eczema.
|
| emollients |
emollients see p. 207.
|
| enalapril |
enalapril (Edynt, Enacord, Innovace, in Innozide, Pralenel) is an ACE inhibitor used to treat raised blood pressure (see Chapter 23) and heart failure (see Chapter 25). Adverse effects include headache, dizziness, fatigue, weakness, nausea, diarrhoea, muscle cramps, altered taste, fall in blood pressure and rarely, skin rashes, allergic swellings of the mouth and throat (angioedema) and a persistent dry irritant cough. Very rarely, it may cause kidney failure. Stop the drug before such procedures. Precautions: Do not use in pregnancy or in patients with aortic stenosis or other obstruction to the outflow of blood from the heart. Use with caution in patients with impaired kidney function, raised blood pressure due to kidney disease, severe congestive heart failure, in breastfeeding mothers and during general anaesthesia. Kidney function tests should be carried out before and at regular intervals during treatment. Interactions: Other anti-blood pressure drugs, lithium, potassium supplements, potassium-sparing diuretics.
|
| enbucrilate |
enbucrilate (Histoacryl, Indermil) is used as a tissue adhesive for closure of minor skin wounds and sealing skin wounds that have been stitched. Within twenty seconds the moisture on the wound causes it to bond. It must be applied very thinly. Do not allow it to come into contact with the eyes, blood vessels, internal organs or nerve tissues.
|
| EnergixB |
EnergixB is a vaccine which contains inactivated hepatitis B virus surface antigen. The vaccine is used in individuals who are at high risk of contracting hepatitis B.
|
| enflurane |
enflurane (Alyrone, Enflurane) is an inhalant anaesthetic similar to halothane but less potent. It is usually given along with a nitrous oxide/oxygen mixture. It depresses breathing which can result in shallow breathing causing the blood level of carbon dioxide to increase. It also depresses the heart and causes a fall in blood pressure. It may interact with dry carbon dioxide adsorbent to form carbon monoxide, therefore do not let carbon dioxide adsorbent dry out.
|
| Eno |
Eno preparations are antacids which contain sodium bicarbonate and sodium carbonate.
|
| enoximone |
enoximone (Perfan) is a selective phosphodiesterase inhibitor which helps to improve the function of heart muscle. It is used to treat congestive heart failure. See Chapter 23. Adverse effects include fall in blood pressure, disorders of heart rhythm, nausea, vomiting, diarrhoea, headache, insomnia and occasionally fever, chills, painful arms and legs and difficulty passing urine. Precautions: Use with utmost caution in patients whose heart failure is due to obstruction to the outflow of blood from the heart and in pregnancy and breastfeeding mothers. Reduce the dose in patients with impaired kidney function and carefully monitor the blood pressure, pulse rate, blood chemistry and liver function and carry out repeated electro-cardiography of the heart (ECGs).
|
| entacapone |
entacapone (Comtess) is used in addition to levodopa and a dopa decarboxylase inhibitor in patients with Parkinson's disease who cannot be stabilised on these combinations alone. See Chapter 16. Adverse effects include movement disorders, stomach and bowel upsets, abdominal pain, dry mouth, reduced haemoglobin levels during long-term treatment and discolouration of urine. Precautions: Do not use in patients with impaired liver function, phaeochromocytoma (tumour of the sympathetic nervous system), in pregnancy or while breastfeeding.
|
| Enterosan |
Enterosan is an antidiarrhoeal preparation which contains belladona, morphine and kaolin.
|
| Entocort CR |
Entocort CR slow-release capsules contain enteric coated granules of the corticosteroid, budesonide. They are used to treat Crohn’s disease (a chronic diarrhoeal disorder). The formulation reduces the risk of general adverse effects and increases the anti-inflammatory effects on the intestine. Entacort enema is used to treat ulcerated bowels affecting the rectum or lower end of the colon. Adverse effects and Precautions see Chapter 37 on corticosteroids. Interactions: cholestyramine. |
| Entonox |
Entonox is a mixture of nitrous oxide 50% and oxygen 50% which is used to produce pain relief without loss of consciousness.
|
| Entrotabs |
Entrotabs is an antacid which contains aluminium, attapulgite and pectin.
|
| enzymes |
enzymes: An enzyme is a protein substance that will start a biochemical reaction. Enzymes are produced by living cells and they may act independently of the cells that produce them but they are an essential constituent of these cells. In medicine enzymes are used to break up clots (see fibrolytics, p. 123) and to dissolve dead skin and debris on wounds and ulcers (see Varidase Topical).
|
| Epaderm |
Epaderm ointment contains yellow soft paraffin and emulsifying wax. It is used to treat dry skin conditions.
|
| ephedrine |
ephedrine (ephedrine hydrochloride, ephedrine sulphate, in Franol, in Franol Plus, in Haymine) is a sympathomimetic drug, see Chapter 9. It is used as a bronchodilator to treat asthma and chronic obstructive airways disease (see Chapter 14), as a decongestant in nasal preparations (see Chapter 10), to reverse the fall in blood pressure associated with spinal anaesthesia and to treat bedwetting in children (see p. 250). Adverse effects: If given to patients sensitive to ephedrine or if given in large doses it may cause nausea, vomiting, giddiness, headache, sweating, thirst, palpitations, anxiety, restlessness, tremor, disorders of heart rhythm, insomnia and muscular weakness. Precautions: It should not be used in patients suffering from high blood pressure, blood clots in the heart, overworking of the thyroid gland, enlargement of the prostate gland or closed-angle glaucoma. It should be given with caution to patients suffering from diabetes. Interactions: MAOIs, anaesthetics, tricyclic antidepressants.
|
| Epiglu |
Epiglu is a tissue adhesive which is used for closure of minor skin wounds and for additional suture support. It contains ethylcyanoacrylate and polymethylmeltacrylate.
|
| eprosartan |
eprosartan (Teveten) is an angiotensin-II receptor blocker used to treat high blood pressure. See Chapter 25. Adverse effects include dizziness, pain in joints, inflammation of the lining of the nose, flatulence, high triglyceride levels. Precautions: Do not use in patients with liver or kidney damage, in pregnancy or while breastfeeding. Use with caution in patients with moderate kidney or liver damage.
|
| eptifibatide |
eptifibatide (Integrilin) is used in the early stages of a heart attack in patients with unstable angina. It is used in conjunction with aspirin and unfractionated heparin. See Chapter 28. Adverse effects include bleeding and heart disorders. Precautions: Do not use in patients with stomach, bowel, genitourinary or other abnormal bleeding within past 30 days, who have had a stroke within past 30 days or have a history of stroke; brain disease; major surgery or severe trauma within past 6 weeks, blood disorders, severe high blood pressure, severe liver or kidney damage, or while breastfeeding. Monitor for signs of bleeding. Use with caution in patients with liver or kidney damage, or in pregnancy.
|
| Equanox |
Equanox is a mixture of nitrous oxide 50% and oxyen 50% which is used to produce pain relief with no loss of consiousness.
|
| ergocalciferol |
ergocalciferol is vitamin D2.
|
| ergometrine |
ergometrine (ergometrine maleate; ergonovine maleate, in Syntometrine) causes contractions of the uterus and is used to prevent bleeding from the uterus after childbirth. Adverse effects include nausea, vomiting, headache, dizziness, noises in the ears (tinnitus), breathlessness, chest pain, palpitations, transient rise in blood pressure, very rarely causes a stroke, heart attack or fluid in the lung. Precautions: It should not be used during the first or second stages of labour since this may cause death of the foetus and rupture of the uterus. Do not use in patients with severe heart disease, disease of the circulation, poor lung function, severe impairment of liver or kidney function, severe raised blood pressure, infections or eclampsia. Use with caution in patients with mild or moderate heart disease or raised blood pressure, blood disorders, porphyria (a hereditary disorder of metabolism) or multiple pregnancies. Interactions: Erythromycin, possibly azithromycin, beta-blockers, sumatriptan. |
| ergotamine |
ergotamine (ergotamine tartrate, in Cafergot, Lingraine, in Migril) is an ergot alkaloid that stimulates and, in large doses, paralyses the endings of the sympathetic nerves. It constricts small arteries and also the uterus. Its main use is in the treatment of migraine. See Chapter 34. Adverse effects: The dose used to treat migraine may cause headache, nausea and vomiting, and occasionally myasthenia gravis (muscle weakness due to neuromuscular abnormality) and pain. In large repeated doses it may produce all the symptoms of ergot poisoning – coldness of the skin, severe muscle pains, gangrene of the hands and feet, blood clots, angina, alteration of heart rate and blood pressure, confusion, drowsiness, paralysis and convulsions. Excessive use may cause scarring (fibrosis) in the chest and abdomen. Precautions: It should not be used in pregnancy, in breastfeeding mothers, in patients with severe raised blood pressure or over-active thyroid glands, in patients with impaired kidney or liver function, coronary artery disease, arterial disease, Raynaud’s syndrome or porphyria (a hereditary disorder of metabolism). It should be used with caution in elderly patients and it should not be used to prevent migraine. Although it relieves headache by contracting small blood vessels it does not relieve visual and other symptoms and it may make vomiting worse. Some patients may become ‘addicted’ to ergotamine and headache may develop if the drug is stopped suddenly. The drug should not be used more than twice a month. Check dose, frequency of dosage and maximum dose carefully. Interactions: Erythromycin and beta-blockers.
|
| Ervenox |
Ervenox is a rubella vaccine which is given by deep subcutaneous or intramuscular injection.
|
| erythromycin |
erythromycin (in Aknemycin Plus, in Benzamycin, Eryacne, Erymax, Erythrocin, Erythroped, Ilosone, in Isotrexin, in Stiemycin, Rommix, Tiloryth, in Zyneryt) is a macrolide antibiotic (see p. 236). Bacteria may quickly become resistant to it. It is partly destroyed by acid in the stomach and has to be taken in specially coated tablets (enteric coated). Adverse effects include nausea, vomiting, abdominal discomfort, diarrhoea (pseudomembranous inflammation of the bowel may occur rarely), allergic reactions, skin rashes, large doses may cause reversible loss of hearing and rarely it may cause jaundice (cholestatic jaundice) and heart disorders (chest pain and disorders of heart rhythm). Precautions: The estolate should not be used in patients with liver disease. Use all other preparations with caution in patients with liver disease. Use with caution in patients with impaired kidney function, porphyria (a hereditary disorder of metabolism), abnormal ECGs (prolonged QT) because ventricular tachycardia has been reported. Use with caution in pregnancy and in breastfeeding mothers. Interactions: Do not use with astemizole or terfenadine; may interact with theophylline, oral anti-coagulants, carbamazepine and digoxin.
|
| erythropoietin |
erythropoietin (epoetin alfa: Eprex; epoetin beta: Recormon) is a hormone produced principally by the kidneys that regulates red cell production by the bone marrow through a process known as erythropoiesis. Sensors of oxygen levels in the tissues are located in the kidneys; if the oxygen level falls, erythropoietin is produced by the kidneys and travels in the blood to the bone marrow, where it stimulates the production of red blood cells in order to increase the oxygen-carrying capacity of the blood. In kidney disease the ability to produce erythropoietin is impaired and the individual develops a reduction in red cell production (anaemia). Following the isolation of the gene coding for human erythropoietin, it is now possible to manufacture it using DNA technology. It is used to treat anaemia associated with kidney failure and patients receiving dialysis and before they receive dialysis. It is also used to prevent anaemias in premature babies under 34 weeks of age. See Chapter 35. Adverse effects include raised blood pressure, headache, blood clot at the site of injection, influenza-like symptoms, seizures and skin rashes. Precautions: Do not use in children or in patients suffering from untreated raised blood pressure. It should be used with caution in patients being treated for raised blood pressure, coronary heart disease, disorders of the circulation, a history of epilepsy or liver failure. Other causes of anaemia should be treated and iron supplements may be needed. The haemoglobin level, platelet count, blood pressure and blood chemistry should be checked at regular intervals. Rise in blood pressure will need treatment. Diet and frequency of dialysis may need to be changed. It should be used with special caution in pregnancy and in breastfeeding mothers.
|
| esomeprazole |
esomeprazole (Nexium) is a proton pump blocker used to treat and prevent heartburn. It is used in combination with antibiotics to eradicate and heal h-pylori-associated duodenal ulcers and to prevent the relapse of peptic ulcers. See Chapter 19. Adverse effects include headache, stomach and/or bowel upsets, skin reactions, dry mouth. Precautions: Do not use in patients with an intolerance to fructose, in patients who are unable to absorb glucose and galactose properly, who have disorders of the enzymes sucrose and isomaltese, or who are breastfeeding. Use with caution in patients with severe kidney or liver damage, on long-term therapy or in pregnancy.
|
| essential oils |
essential oils are volatile mixtures of various chemicals that give off particular odours. Taken by mouth volatile oils irritate the mucous membranes of the mouth and stomach and give a feeling of warmth. They increase salivation, and relax the muscles at the entrance to the stomach and the muscles of the intestine. Various essential oils are used to relieve a sore throat, to relieve stomach wind (e.g. gripe water for babies) and to relieve the symptoms of an irritable bowel (e.g. peppermint oil). When applied to the skin essential oils have an irritant effect and some of them are included in rubefacients (rheumatic rubs). They are also used as flavouring agents in some cold and cough remedies. Adverse effects: Excessive use by mouth may irritate the stomach and bowel (causing nausea and vomiting and diarrhoea) and the lining of the bladder and urethra (causing symptoms like cystitis). Overdose by mouth may depress breathing and affect the brain producing excitement, convulsions and stupor. They may irritate the skin and cause contact dermatitis.
|
| estramustine |
estramustine (Estracyt) is used to treat cancer of the prostate gland. It is a combination of an oestrogen and an anti-cancer drug (mustine). It delivers the mustine to the oestrogen receptors in the tumour. Adverse effects: Nausea, vomiting, diarrhoea, allergic skin rash and fever, rarely thrombocytopenia (a fall in blood platelets), enlarged breasts (gynaecomastia) and damage to the heart may occur. Precautions: It should not be used in patients with peptic ulcers, severe liver disease, severe heart disease or impaired bone-marrow function. Interactions: Milk and milk products.
|
| etamsylate |
etamsylate (Dicynene) is a haemostatic (it helps to stop bleeding, see p. 124). It is used in the treatment of heavy periods and to prevent bleeding in premature, low birth-weight babies. Adverse effects include nausea, headache and rashes. Precautions: Do not use in patients suffering from porphyria (a hereditary disorder of metabolism).
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| etanercept |
etanercept (Enbrel) is used to treat active rheumatoid arthritis and active juvenile chronic arthritis which does not respond to methotrexate treatment. See Chapter 17. Adverse effects include injection site reactions, infection, headache, dizziness, weakness, abdominal pain, indigestion, rash, tumours, heart disorders, inflammation of the gall bladder, inflammation of the pancreas, bleeding in the stomach and bowel, inflammation of joints, depression, difficulty breathing, CNS demyelinating disorders (including multiple sclerosis and optic neuritis). Precautions: Do not use in patients with infection or at risk of infection, pregnancy (ensure adequate contraception) or while breastfeeding. Use with caution in patients with a history of recurrent infection or a predisposition to infection, immunosuppression, exposure to chicken pox, history of blood disorders, CNS demyelinating disorders (eg. multiple sclerosis, optic neuritis).
|
| ethambutol |
ethambutol (ethambutol hydrochloride) is used to treat tuberculosis. See Chapter 50. Adverse effects: Its most serious adverse effect is impaired vision (e.g. colour blindness) which may occur if high doses are used, particularly in patients with impaired kidney function. It is reversible if the drug is stopped early enough. It may also cause nerve damage. Precautions: It should be used with caution in pregnancy, in breastfeeding mothers and in patients with impaired kidney function. Blood levels must be checked. The eyes should be examined before treatment and at frequent intervals during treatment. It should not be used in young children or in patients with optic neuritis (inflammation of the optic nerve causing impairment of vision).
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| ethanolamine oleate |
ethanolamine oleate is used to strengthen the walls of varicose veins. Adverse effects: Leakage may lead to damage (necrosis) of the surrounding tissue. It may rarely cause allergic reactions. Precautions: It should not be used in patients whose veins are so painful that they cannot walk, who have inflammation of a vein, who are taking oral contraceptive drugs or have obese legs.
|
| ether |
ether is occasionally used as a general anaesthetic.
|
| ethoheptazine |
ethoheptazine (in Equagesic) is a mild to moderate opiate pain-reliever. It may produce stomach discomfort, nausea, dizziness, drowsiness and itching. It is structurally related to pethidine.
|
| ethosuximide |
ethosuximide (Emeside, Zarontin) is an anti-convulsant drug used to treat epilepsy. See Chapter 15. Adverse effects include stomach and bowel upsets, headache, fatigue, lethargy, dizziness, hiccups, drowsiness, apathy, mood changes and loss of control over voluntary movements (ataxia). It may, rarely, cause skin rashes, blood disorders, impaired liver and kidney function, systemic lupus erythematosis (SLE - a disease of unknown cause with symptoms of fever, pain, blood disorders and skin eruptions), overgrowth of the gums, swelling of the tongue, irritability, night tremors, sleep disturbances, poor concentration, increased libido, shortsightedness and vaginal bleeding. Precautions: Do not use in patients with porphyria (a hereditary disorder of metabolism). It should be given with extreme caution in pregnancy, in breastfeeding mothers and in patients with impaired liver or kidney function. Blood counts and tests of liver and kidney function should be carried out at regular intervals during treatment. The drug should be withdrawn slowly. Interactions: Phenothiazines, antihistamines, antidepressants.
|
| ethylene glycol |
ethylene glycol is included in sunscreen lotions and protective creams. It should only be present in a very low concentration and should not be applied extensively on the body.
|
| etidronate disodium |
etidronate disodium (Didronel) is a diphosphonate that slows down the laying down and dissolving of bone and reduces the increased turnover of bone that occurs in Paget’s disease. Didronel PMO tablets (etidronate disodium combined with effervescent calcium carbonate) is used to treat osteoporosis of the spine. Adverse effects include nausea, diarrhoea and increased bone pain (in Paget’s disease). Infusion may cause metallic or altered taste. There is an increased risk of fractures with high doses in Paget’s disease. Rare adverse effects include allergic skin reactions (swelling of the face, hands and feet, nettle rash, itching), abdominal pain, constipation, headache, pins and needles in the hands and feet, nerve damage and blood disorders. Increase in blood calcium and phosphate levels may occur. Precautions: Adequate intake of calcium and vitamin D must be maintained. Do not use in patients with moderate or severe impairment of kidney function. Use with caution in patients with mild impairment of kidney function or inflammation of the bowel. Kidney function tests should be carried out before treatment and at regular intervals during treatment. Dose should be reduced if there is mild or moderate impairment of kidney function. Do not use in pregnancy or in breastfeeding mothers. Do not use to treat osteoporosis if blood level of calcium is raised or if there is a high level of calcium in the urine. Do not use to treat adult rickets. Blood phosphate and alkaline phosphatase levels and urinary hydroxyproline levels should be measured before treatment and then every three months.
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| etomidate |
etomidate (Hypnomidate) is used as an intravenous anaesthetic. It may cause pain at the site of injection. Repeated doses may damp down the adrenal glands causing a fall in the production of corticosteroids (see Chapter 37). It should not be used in patients with porphyria (a hereditary disorder of metabolism).
|
| etonogestrel |
etonogestrel (Implanon) is an implant used for long-term reversible contraception which lasts for up to 3 years. The implant is inserted under the skin on the inner side of the upper arm. See Chapter 41. Adverse effects include acne, headache, weight gain, breast tenderness, hair loss, depression, changes in libido, emotional swings, abdominal pain and difficult or painful menstruation. Precautions: Do not use in patients with thromboembolic disorders (blood clots), progestogen-dependent cancers, history of severe liver disease, undiagnosed vaginal bleeding or in pregnancy. Use with caution in patients with high blood pressure, liver damage, diabetes, chloasma (patchy brown pigmentation on the face), heavier women, history (during pregnancy or previous use of sex steroids) of jaundice, itching due to jaundice, gallstones, porphyria (a hereditary disorder of metabolism), systemic lupus erythematosis (SLE - a disease of unknown cause with symptoms of fever, muscle and joint pain, blood disorders and skin eruptions), haemolytic uraemic syndrome (a blood disorder), Sydenham’s chorea (a childhood disorder with symptoms of rapid jerky movements with low muscle tone and reflexes, and mental disturbance), herpes occurring during pregnancy, otosclerosis (the development of an extra bone in the ear causing progressive deafness).
|
| etoposide |
etoposide (Etopophos, Vepesid) is used as an anti-cancer drug. See Chapter 51. Adverse effects include nausea, vomiting, loss of hair and damage to the bone marrow causing blood disorders. Precautions see Chapter 51.
|
| eucalyptol |
eucalyptol has the actions and uses of eucalpytus oil but it is less irritating. It is used as a heat rub, and it has some antiseptic properties. It is used in temporary dental fillings.
|
| eucalyptus oil |
eucalyptus oil has a pleasant smell and is included in medicines used to treat symptoms of the upper respiratory tract. It is an irritant to the skin, mouth and nose. It is used in some rheumatic liniments and in preparations to treat wind.
|
| Eugynon-30 |
Eugynon-30 is a combined oral contraceptive. See p. 189.
|
| exemestane |
exemestane (Aromasin) is an anti-oestrogen used to treat advanced post-menopausal breast cancer that has progressed following anti-oestrogen therapy. See Chapter 40. Adverse effects include hot flushes, nausea, fatigue, sweating, dizziness, headache, insomnia, pain, rash, weight changes, anorexia, abdominal pain, depression, hair loss, swelling of the legs and arms, constipation, indigestion, disorders of the blood. Precautions: Do not use in pre-menopausal women, in pregnancy or while breastfeeding. Use with caution in patients with liver or kidney damage.
|
| expectorants |
expectorants see Chapter 11.
|
| Exterol |
Exterol ear drops contain urea hydrogen peroxide in glycerine. It is used to remove ear wax (see p. 48) Adverse effects: include irritation. Precautions: Do not use if ear drum is perforated.
|
| eye preparations |
eye preparations see Chapter 13.
|
| factor IX fraction, dried |
factor IX fraction, dried (Alphanine, Benefix, Dried Factor IX Fraction, Human Factor IX Concentrate Heat Treated, Mononine, Replenine) is prepared from human plasma. It also contains clotting factors II, VII and X. It is used to treat haemophilia B due to a deficiency of factor IX and hereditary deficiency of factor IX (Christmas factor). Adverse effects include allergic reactions, chills and fever. Precautions: Do not use in patients with a generalized clotting disorder (disseminated intravascular coagulation). There is a risk of blood clots with low purity products.
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| factor VIII inhibitor bypassing fraction |
factor VIII inhibitor bypassing fraction is prepared from human plasma. It is used in patients who have developed inhibitors to factor VIII therapy.
|
| faecal softeners |
faecal softeners see Chapter 21.
|
| famciclovir |
famciclovir (Famvir) is an antiviral drug (see Chapter 48) used to treat shingles (herpes zoster) and genital herpes (herpes simplex). Adverse effects include headache and nausea. Precautions: Do not use in pregnancy or breastfeeding mothers. Use with utmost caution in patients with impaired kidney function. It is taken by mouth as tablets.
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| famotidine |
famotidine (Pepcid, Pepcid AC) is an H2 blocker used to treat peptic ulcers and acid reflux (see Chapter 19). Adverse effects include headache, dizziness, constipation, diarrhoea. Less frequently, dry mouth, nausea, skin rash, stomach upsets, loss of appetite, fatigue. Rarely it may cause reversible enlargement of the breasts (in men) and a very serious skin rash – toxic epidermal necrosis. Precautions: Use with caution in patients with impaired kidney function or stomach cancer (may mask symptoms), and use with caution in pregnancy and breastfeeding mothers. See also under cimetidine but famotidine does not affect enzymes in the liver that metabolize certain drugs.
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| Fefol |
Fefol spansules contain ferrous sulphate and folic acid. See Chapters 35 and 36.
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| Femodene |
Femodene is a combined oral contraceptive. See p. 189.
|
| Femodette |
Femodette is an oral contraceptive pill containing gestodene and ethinylestrdiol. See p.189.
|
| Femulen |
Femulen is a progestogen-only oral contraceptive containing etynodiol. See p. 190.
|
| fentanyl |
fentanyl (Actiz, in Durogesic, Sublimaze) is an opiate pain-reliever (see Chapter 30) used during surgical operations and to depress respiration in patients on ventilators. Adverse effects include fall in blood pressure, slowing of pulse rate, depression of respiration, nausea and vomiting. Precautions: Use with caution in patients with chronic chest disease, myasthenia gravis (muscle weakness due to neuromuscular abnormality), under-active thyroid, impaired liver function and in elderly patients. Its use in childbirth may depress breathing in the newborn baby.
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| Ferfolic SV |
Ferfolic SV tablets contain folic acid, ferrous gluconate and vitamin C. They are used to treat iron and folic acid deficiency and to prevent neural tube damage (e.g. spina bifida) in women known to be at risk (see p. 155). Adverse effects include nausea and constipation. Precautions: Do not use to treat megaloblastic anaemia (e.g. pernicious anaemia). Interactions: Tetracycline antibiotics.
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| Fermathron |
Fermathron is a sodium hyaluronate preparation which is injected into a knee joint to supplement natural hyaluronic acid in the synovial (joint) fluid. It is used in the treatment of osteoarthritis of the knee.
|
| ferric ammonium citrate |
ferric ammonium citrate (in Lexpec with iron, in Lexpec with iron M) is a form of iron. The mixture should be well diluted with water and sucked through a straw to prevent discoloration of the teeth. See Chapter 35 on iron.
|
| Ferrograd C |
Ferrograd C timed-release tablets contain ferrous sulphate and ascorbic acid. The vitamin C helps the absorption of the iron. Precautions: Do not use in patients with diverticular disease or intestinal obstruction. Interactions: tetracycline antibiotics, levodopa.
|
| Ferrograd Folic |
Ferrograd Folic timed-release tablets contain ferrous sulphate and folic acid. They are used to treat anaemia in pregnancy, see p. 155. Precautions: Diverticular disease, intestinal obstruction, vitamin B12 deficiency. Interactions: tetracycline antibiotics, levodopa.
|
| fexofenadine |
fexofenadine (Telfast) is used to treat seasonal allergic rhinitis (hayfever). See Chapter 17. Adverse effects include headache, nausea, dizziness, fatigue. Precautions: Do not use in pregnancy. Use with caution in patients who are breastfeeding.
|
| fibrates |
fibrates, see Chapter 26. Warning: these drugs can damage muscle tissue causing muscle pains and weakness and a rise in CPK (creatine phosphokinase) in the blood. This enzyme is raised when muscles are damaged and its level gives an indication of the degree of damage. Patients with impaired kidney function or underworking of the thyroid gland are at particular risk. Do not use a fibrate drug with a statin drug or with ciclosporin because this will increase the risks. CPK levels must be measured during treatment and patients should report any muscle pains or weakness.
|
| fibrinogen |
fibrinogen is a factor in blood which helps it to clot. See Chapter 28.
|
| fibrinolytic drugs |
fibrinolytic drugs see p. 123.
|
| filgrastim |
filgrastim (Neupogen) is used to reduce the incidence and duration of reductions in neutrophil white blood cells (neutropenia) which may occur in individuals being treated with anti-cancer drugs for cancers not affecting the blood-forming tissues. Filgrastim is a bio-engineered human growth factor that stimulates the production of white blood cells. The growth factor is referred to as human granulocyte colony stimulating factor (G-CSF) because it stimulates the growth of colonies of granulocytes (white blood cells) in the bone marrow and elsewhere. Following the injection of a single dose into a vein or under the skin the number of white cells falls during the first hour and then increases over the next 4–5 hours. The white cell count rapidly returns to normal when the injections are stopped and there is no evidence of a rebound fall in the number of white blood cells. The response to filgrastim is very selective in affecting neutrophils but not other white blood cells. The effect is similar to that seen in healthy individuals during an infection and it therefore helps to reduce the risk of infection which is a problem in anyone whose neutrophil white cell production is knocked out by anti-cancer drugs. Adverse effects include pains in joints and muscles, difficulty and/or discomfort on passing urine, raised blood uric acid levels, headache, diarrhoea, nose bleeds, loss of hair, transient fall in blood pressure, disturbances in liver function tests, allergic reactions, proteins and blood in the urine and a transient fall in blood sugar level. Long-term use may be associated with damage to blood vessels in the skin, enlargement of the liver, skin rash and osteoporosis. Precautions: Do not use in patients with severe congenital neutropenia (Katsman’s syndrome) with abnormal cell genetics. It should not be used within 24 hours before or after anti-cancer drug treatment. It should not be used in individuals with cancer of the blood-forming tissues. It should be used with caution in patients with severely impaired kidney and liver function. White blood cell counts must be carried out at frequent intervals because of the risk of over-production of white blood cells. Monitor blood platelet and haemoglobin level and spleen size. Use with utmost caution in pregnancy and breastfeeding mothers. Bone density must be monitored in individuals with osteoporosis on long-term treatment.
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| finasteride |
finasteride (Proscar) blocks the enzyme that converts the male sex hormone, testosterone, into a more potent form (dihydrotestosterone). This reduces the amount in the body which helps to reduce the size of the prostate gland. This improves passing urine in men with benign enlargement of their prostate gland, see p. 251. Adverse effects include impotence, decreased libido, reduced amount of ejaculate, tenderness and enlargement of the breasts and allergic reactions. Precautions: Do not use to treat cancer of the prostate. Finasteride is excreted in the semen, therefore a condom should be worn if sexual partner is pregnant or of child-bearing potential. Women who are pregnant or of childbearing potential should not handle broken or crushed tablets.
|
| flecainide |
flecainide (flecainide acetate, Tambocor) is used to treat disorders of heart rhythm. See Chapter 24. Adverse effects include dizziness, visual disturbances, nausea, vomiting, disturbed liver function, jaundice, nerve damage, pins and needles, unsteadiness of movement (ataxia) and sensitivity of the skin to the sun’s rays. Precautions: Do not use in patients with heart failure, with a history of a heart attack, with an irregular heartbeat, serious heart valve disease, heart block or sinus node disease in absence of a pacemaker. Use with utmost caution in the elderly and in patients with impaired kidney or liver function, heart disease, in pregnancy, in breastfeeding mothers, or in patients with an irregular heartbeat following heart surgery. Interactions: Other class I anti-arrhythmic drugs, digoxin and drugs that depress heart function.
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| Fleet Enema, Fleet Ready-to-use Enema |
Fleet Enema, Fleet Ready-to-use Enema contain sodium acid phosphate. They are used to treat constipation or bowel evacuation before abdominal procedures such as surgery or endoscopy.
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| Fleet Phospho-soda |
Fleet Phospho-soda is an oral sodium phosphate solution used for clearing the bowel before X-ray, endoscopy or surgery. See Chapter 21. Precautions: Do not use if bowel lining is damaged so that its ability to absorb fluid and electrolytes is increased. Do not use in patients suffering from congestive heart failure. Use with caution in patients on a salt (sodium salt) restricted intake.
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| Fletchers’ Arachis Oil Retention Enema |
Fletchers’ Arachis Oil Retention Enema contains arachis oil (peanut oil). It lubricates and softens impacted faeces. Precaution: The enema should be warmed to body temperature before use. See Chapter 21.
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| Fletchers’ Enemette |
Fletchers’ Enemette contains docusate sodium, glycerol, macrogol and sorbic acid. It lubricates and softens impacted faeces. See Chapter 21.
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| Fletchers’ Phosphate Enema |
Fletchers’ Phosphate Enema contains sodium acid phosphate and sodium phosphate, which act as an osmotic laxative. See Chapter 21.
|
| Fluarix |
Fluarix is a flu vaccine. See Chapter 53 on vaccines.
|
| fluconazole |
fluconazole (Diflucan) is an antifungal drug. See Chapter 47. Adverse effects include stomach and bowel upsets, and rarely, allergic reactions and very serious skin rashes (particularly in patients suffering from AIDS). Precautions: It should not be used in pregnancy or in breastfeeding mothers. Use multiple dose treatment with caution in patients suffering from impaired kidney function. Interactions: Anticoagulants, theophylline, rifampicin, cyclosporin, phenytoin, sulphonylurea anti-diabetic drugs, astemizole, terfenadine.
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| flucytosine |
flucytosine (Alcobon, Ancotil) is an antifungal drug. See Chapter 47. Adverse effects include nausea, vomiting, diarrhoea, rashes, confusion, hallucinations, convulsions, headache, vertigo, sedation, liver damage and blood disorders. Precautions: It should be used with caution in patients with impaired kidney or liver function, in pregnancy, in the elderly, in breastfeeding mothers and in patients with blood disorders.
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| fludarabine |
fludarabine (Fludara) is an anti-cancer drug (see Chapter 51) used to treat chronic lymphatic leukaemia. Adverse effects include damage to the bone marrow producing blood disorders. It also suppresses the immune system which reduces the individual’s resistance to infection. Rarely it may affect the nervous system and lungs. Precautions: Reduce dose in patients with impaired kidney function. See Chapter 51. |
| fludrocortisone |
fludrocortisone (fludrocortisone acetate, Florinef ) is a synthetic mineralocorticoid which can regulate the body’s water and electrolyte balance. It is used as partial replacement treatment in patients suffering from underworking of the adrenal glands (Addison’s disease). Adverse effects and Precautions see Chapter 37.
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| flumazenil |
flumazenil (Anexate) is a benzodiazepine blocker (antidote). It displaces benzodiazepines from their receptor sites and reverses their sedative and sleep-producing effects within 30–60 seconds of an intravenous injection. It is used to reverse the effects of benzodiazepines that have been used during anaesthesia, intensive care or in diagnostic procedures (e.g. endoscopy). Adverse effects include nausea, vomiting, flushing, transient rise in blood pressure, increase in heart rate and, rarely, seizures (particularly in epileptics). If awakening is too rapid patient may feel fearful, anxious, and agitated. Precautions: Do not use in patients allergic to benzodiazepines. Rapid or excessive amounts of injection may trigger withdrawal symptoms in patients on long-term treatment with benzodiazepines. Do not give to epileptics who are on long-term benzodiazepine treatment. Do not give to a patient under anaesthesia until the effects of any neuro-muscular blocking drug have completely worn off. Flumazenil works for 2–3 hours, so that any underlying sedation produced by a benzodiazepine may re-emerge. Use with caution in pregnancy and in breastfeeding mothers, in the elderly, in patients with head injury or impaired liver function. It is short-acting and repeated doses may be necessary but note that the effects of benzodiazepines can last for 24 hours. Use with caution in patients dependent on benzodiazepines, it may trigger withdrawal symptoms. Do not give injections rapidly in anxious patients and following major surgery.
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| flunisolide |
flunisolide is a corticosteroid used in a nasal spray (Syntaris) to treat hay-fever. Adverse effects see Chapter 37 on corticosteroids. It may produce irritation of the nose. Do not use in patients with untreated infections of the nose. Use with caution in patients who have recently had ulcers in the nose or injury or surgery to the nose. Use with caution in pregnancy.
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| fluocinolone |
fluocinolone (fluocinolone acetonide, Synalar preparations) is a corticosteroid used in skin and scalp applications. Adverse effects and Precautions see corticosteroid skin applications p. 211.
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| fluocinonide |
fluocinonide (Metosyn) is a corticosteroid used in skin and scalp applications. Adverse effects and Precautions see corticosteroid skin applications p. 211.
|
| fluocortolone |
fluocortolone (fluocortolone hexanoate, Ultradil plain, Ultralanum plain, in Ultraproct) is a corticosteroid used in skin applications. Adverse effects and Precautions see corticosteroid skin applications p. 211.
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| fluorescein |
fluorescein (Minims fluorescein, Minims lignocaine and fluorescein, in Minims proxymetacaine & fluorescein) is used to stain the eye in order to highlight any scar or foreign particle.
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| Fluoride |
Fluoride (En-De-Kay, Fluor-a-Day). It has now been convincingly demonstrated that in those parts of the world where the natural water contains more than one part per million of fluoride, the incidence of dental caries is lower than in comparable areas where the natural water contains less fluoride. Fluoride increases the resistance of the enamel of the teeth to acid, improves the laying down of minerals in teeth and interferes with bacterial growth. It is most effective if it is taken when the enamel is being laid down on the teeth before they erupt – that is, in childhood. If fluoride is deposited at this stage the teeth will be more resistant to dental caries than teeth that have not had fluoride deposited in them. In parts of the world where there is a high concentration of fluoride in the drinking water the teeth may become mottled, with dull and pitted enamel. This is called fluorosis. There is, however, no risk to health and the teeth are resistant to caries. Where the drinking water contains very high amounts of fluoride (over 10 parts per million) the bones may become hardened (sclerosed) and calcium may be laid down in tendons and ligaments. If the natural fluoride content of drinking water is less than one part per million, artificial fluoridation is the most economic method of supplementing fluoride intake. Daily supplements of fluoride should not be used without knowledge of the fluoride content of the local drinking water. They are not necessary if the water contains 0.7 parts or more per million. Infants under six months of age do not require fluoride supplementation. The local effect of fluoride on the enamel and plaque is more effective in stopping caries than systemic fluoride (i.e. fluoride tablets etc. to be swallowed). Local preparations include mouth rinses, gels and varnishes.
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| fluorometholone |
fluorometholone (FML) is a corticosteroid used to treat inflammation of the eye. Adverse effects include a rise in pressure in the eye, thinning of the cornea, cataract and risk of fungal infections. Precautions: Do not use if viral, fungal or tuberculous infection is present. Do not use if infection is causing a yellow discharge (purulent). Do not wear soft contact lenses while on treatment. Use with utmost caution in patients with glaucoma and be cautious about prolonged use in pregnancy and infants.
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| fluorouracil |
fluorouracil (Efudix) is an anti-cancer drug, see Chapter 51. Adverse effects include nausea, vomiting, loss of appetite, severe diarrhoea, skin rash (dermatitis), loss of hair (alopecia), nail damage, and pigmentation of the skin. It may produce damage to the lining membrane of the mouth, stomach and intestine, fever, bone-marrow damage leading to blood disorders and damage to part of the brain (the cerebellum). Precautions: It should not be given to patients whose bone-marrow function may be depressed and it should be given with caution to patients whose liver function is impaired.
|
| fluoxetine |
fluoxetine (Felicium, Prozac) is a 5HT re-uptake blocker used to treat depression. See Chapter 4. It is also used to treat bulimia and obsessive compulsive disorders. Adverse effects include nausea, vomiting, indigestion, abdominal pains, diarrhoea, constipation, loss of appetite, loss of weight, changes in blood sugar levels, dry mouth, anxiety, nervousness, weakness, headache, tremor, palpitations, insomnia, dizziness, drowsiness, sweating, fever, confusion, hypomania, mania, convulsions, sexual dysfunction, movement disorders, neuro-malignant syndrome-like events (see under antipsychotic drugs), low blood sodium levels, abnormal liver function tests, rash or allergic reactions (stop if they develop), blood disorders, stroke, bruising, bleeding from the stomach and intestine, inflammation of the pancreas, hair loss, violent behaviour, ideas about violent suicide, and vaginal bleeding when the drug is stopped. Precautions: Do not use in patients with severe impairment of kidney function, unstable epilepsy, in breastfeeding mothers or in manic phase of manic depression. Use with caution in patients with heart disease, epilepsy, history of mania, patients recovering from ECT treatment (risk of prolonged convulsions). Use with caution in pregnancy and in patients with diabetes or impaired heart, kidney or liver function. Avoid abrupt withdrawal. Interactions: MAOIs, tryptophan, tricyclic antidepressants, lithium, flecainide, tryptophan, vinblastine, carbamazepine, phenytoin.
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| flupentixol |
flupentixol (Depixol, Fluanxol) is a thioxanthene antipsychotic drug (see Chapter 3) which also produces antidepressant effects when given in low doses (see Chapter 4). Adverse effects include insomnia and restlessness. Occasionally it may cause headache, dizziness, visual disturbances, tremor and movement disorders (e.g. parkinsonism). Precautions: Use with caution in patients with heart diseases, impaired kidney or liver function, arteriosclerosis, lung disease, senile confusion, parkinsonism, porphyria (a hereditary disorder of metabolism). Do not use in patients who are over-active and excitable. Do not use in pregnancy or in breastfeeding mothers or in comatose patients. Drowsiness may affect driving ability. Interactions: Alcohol, sleeping drugs, sedatives, anti-anxiety drugs or any drug that depresses brain function, opiate pain-relievers, anti-blood pressure drugs, anti-epileptic drugs, levodopa.
|
| flutamide |
flutamide (Chimax, Drogenil) is a non-steroidal anti-androgen used to treat cancer of the prostate gland. Adverse effects include tenderness and enlargement of the breasts with milk production, and occasionally, nausea, vomiting, increased appetite, diarrhoea, tiredness, insomnia, decreased libido, stomach and chest pains, thirst, blurred vision, headache, dizziness, fluid retention, itching, rashes, liver damage, jaundice, blood disorders and harmful effects on the brain (encephalopathy). Precautions: Do not use in patients who are allergic to the drug. Tests of liver function should be carried out before and at regular intervals during treatment. It may cause fluid retention in patients which will aggravate heart disease.
|
| fluticasone |
fluticasone is a corticosteroid (see Chapter 45) used as a cream (Cutivate) to treat eczema and dermatitis, as a nasal aerosol (Flixonase) to treat hayfever (see p. 74) and as a disk inhaler (Flixotide, in Seretide) to treat and prevent bronchial asthma (see Chapter 14). Adverse effects and Precautions see Chapter 37 on corticosteroids. Inhalations to treat asthma may cause hoarseness, thrush of the mouth and throat and may rarely trigger wheezing. They should be used with caution in patients with tuberculosis and in pregnancy. Nasal sprays may cause irritation of the nose, disturbances of smell and taste and occasionally nose bleeds. Use with caution in pregnancy and breastfeeding mothers. Adverse effects and Precautions see corticosteroid skin applications p. 211.
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| Fluvoxamine |
Fluvoxamine (fluvoxamine maleate, Faverin) is an antidepressant drug which blocks 5 HT (serotonin) re-uptake. See Chapter 4. Adverse effects include sleepiness, agitation, tremor, nausea, loss of appetite, vomiting, diarrhoea, constipation, dry mouth, abdominal pains, indigestion, headache, generally feeling unwell, insomnia, palpitations, sweating, dizziness, anxiety, nervousness, convulsions, liver disorders and decreased heart rate. Precautions: It should be used with utmost caution during pregnancy, in breastfeeding mothers, and in patients with epilepsy. Reduced dosage should be used in patients with impaired kidney or liver function. It may increase the effects of alcohol. Interactions: Theophylline, aminophylline, clozapine, propranolol, carbamazepine, benzodiazepines, warfarin, MAOIs, tricyclic antidepressants, alcohol, phenytoin, lithium and tryptophan.
|
| folic acid |
folic acid (pteroylglutamic acid, Folicare, Lexpec, Pre-conceive) is necessary for cell division and for the normal production of red blood cells, see Chapter 36 on vitamins. Adverse effects: Large and continuous doses of folic acid may lower the blood level of vitamin B12 which is essential to the normal production of red blood cells. Precautions: Folic acid should not be used to treat pernicious anaemia and other vitamin B12 deficiency disorders because it may trigger the onset of spinal cord degeneration. Do not use in cancer patients unless megaloblastic anaemia due to folic acid deficiency is a complication. For use in pregnancy, see p. 155.
|
| folinic acid |
folinic acid is an active breakdown product (active metabolite) of the B vitamin folic acid. See Chapter 36. Its calcium salt (calcium folinate, Calcium Leucovorin, Refolinon) is used to counter the anti-folate actions of the anti-cancer drugs methotrexate and trimetrexate. It reduces the toxicity of these drugs, a process referred to as ‘folinic acid rescue’. Folinic acid is also used to treat folate deficiency megaloblastic anaemias, but it should not be used to treat pernicious anaemia or other magaloblastic anaemias when vitamin B12 is deficient. See Chapter 36. Folinic acid (as Lederfolin) also interacts with the anti-cancer drug fluorouracil to benefit patients being treated with fluorouracil for cancer of the bowel that has produced secondaries. Adverse effects include occasional allergic reactions and fever following intravenous administration. Precautions: Do not give at the same time as methotrexate – give 24 hours after the last dose. It must be administered during treatment with trimetrexate and continued for 72 hours after the last dose of trimetrexate.
|
| fomivirsen |
fomivirsen (Vitravene) is used for second line treatment of cytomegalovirus (CMV) infections of the retina in AIDs patients. See Chapter 48. Adverse effects include abnormal vision, swelling at the injection site, inflammation of the eye, cataract, eye pain, bleeding from the eye and detachment of the retina. Precautions: Do not use in patients with eye infections. Use with caution in patients who are pregnant or breastfeeding, have CMV infections of the retina in the other eye, CMV infections outside the eye and patients with sight-threatening diseases.
|
| formaldehyde solutions |
formaldehyde solutions (formalin, Veracur) are used in varying strengths as antiseptics, disinfectants, for removing dead skin to treat warts and verrucas and to treat sweaty feet. It may irritate skin. Avoid contact with healthy skin and the eyes and mouth.
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| formestane |
formestane (Lentaron) blocks the enzyme in women that converts male sex hormones (androgens) into female sex hormones (oestrogens). It is used to treat cancer of the breast in women who have undergone the menopause whether naturally or artificially. Adverse effects include hot flushes, itching, skin rashes, growth of hair on the face, loss of hair from the scalp, drowsiness, lethargy, headache, nausea, vomiting, constipation, emotional upsets, dizziness, swelling of the legs, vaginal bleeding, pelvic cramps, joint pains, muscle cramps, sore throat, severe allergic reactions, and pain and irritation at the site of injection. Precautions: Do not use in pre-menopausal women, in pregnancy or in breastfeeding mothers. Avoid injection directly into a nerve or vein. Drowsiness may affect driving ability.
|
| formoterol (eformoterol) |
formoterol (eformoterol) (Foradil, Oxis, Symbicort) is a selective beta2 stimulant used as a bronchodilator to treat asthma. See Chapter 14. Adverse effects and Precautions are similar to those listed under salbutamol.
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| fosinopril |
fosinopril (Staril) is an ACE inhibitor used to treat raised blood pressure (see Chapter 25), and heart failure in combination with a diuretic (see Chapter 23). Adverse effects include dizziness, stomach and bowel upsets, cough, chest pain, palpitations, fatigue, skin rash, muscle and joint pains and taste disturbances. Rarely, it may cause allergic swellings of the hands, face and feet (stop the drug immediately) and inflammation of the pancreas. Precautions: It should not be used in pregnancy and in breastfeeding mothers. It should be used with caution in individuals with impaired liver or kidney function, congestive heart failure, raised blood pressure associated with impaired kidney function, patients on blood dialysis and patients who are depleted of salt and water. Interactions: Potassium-sparing diuretics, potassium supplements, NSAIDs, antacids, lithium, anti-blood pressure drugs.
|
| fosphenytoin |
fosphenytoin (Pro-Epanutin) is given by injection to control epilepsy. It is used to prevent and treat seizures associated with neurosurgery or head trauma. It is used as a substitute for oral phenytoin when oral administration is not possible. See Chapter 15. Adverse effects include heart complications, disorders of the blood, nerve disorders, liver and kidney damage, stomach and bowel upset, itching, headache, unusual hair growth, allergic reactions. Precautions: Do not use in patients with slow heart beat, heart block, Adams-Stokes syndrome (fainting caused by a problem in the heart), porphyria (a hereditary disorder of metabolism), or while breastfeeding. Use with caution in patients with low blood pressure, impaired heart, kidney or liver function, hypoalbuminaemia (low level of albumin in the blood), diabetes, in the elderly or in pregnancy.
|
| frangula |
frangula (in Normacol Plus) is a bulk laxative. See Chapter 21.
|
| fresh frozen plasma |
fresh frozen plasma is obtained from one donation of whole blood. It is used to replace coagulation factors or other plasma proteins. Adverse effects include allergic reactions, chills, fever, wheezing and adult respiratory stress syndrome. Precautions: Blood groups must be compatible and overload of the circulation must be avoided.
|
| Fuller’s Earth |
Fuller’s Earth (terra fullonica) consists largely of montmorillonite, an aluminium silicate with chalk (calcite). It is adsorbent and is used in dusting powders, toilet powders and lotions. It is also used to treat paraquat poisoning.
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| furosemide(frusemide) |
furosemide(frusemide) (in co-amilofruse, in Diumide-K Continus, Froop, in Fru-Co, in Frumil, in Frusene, Frusol, in Lasical, in Lasilactone, Lasix, in Lasoride, Min-I-Jet furosemide(frusemide), Rusyde) is a loop diuretic (see Chapter 29). Adverse effects include a fall in blood sodium, potassium and magnesium and increase in the excretion of calcium. It may cause nausea, vomiting, diarrhoea, blurred vision, yellow vision, headache, dizziness, allergic reactions, skin rashes, sensitivity of the skin to sunlight, fall in blood pressure, raised blood uric acid levels and gout, raised blood glucose, transient increase in blood cholesterol and fats and, very rarely, jaundice and damage to the bone marrow, producing blood disorders. Noises in the ears (tinnitus) and deafness may develop in patients with impaired kidney function, particularly if high doses are given rapidly into a vein. Large doses intravenously may very rarely damage the pancreas (pancreatitis). Precautions: Do not use in patients in pre-comatose states associated with cirrhosis of the liver. It should be used with caution in patients with liver or kidney impairment, diabetes, gout, in pregnancy and in breastfeeding mothers. Because it increases the volume of urine it should be used with caution in anyone who has difficulty in passing urine, for example, men with enlarged prostate glands. It causes a fall in blood potassium and sodium levels and therefore the blood chemistry should be carefully monitored, particularly in elderly patients and in patients with impaired kidney or liver function. Interactions: Digoxin and related drugs, lithium, aminoglycoside antibiotics, cephalosporin antibiotics, anti-blood pressure drugs, NSAIDs.
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| fusafungine |
fusafungine (Locabiotal aerosol) is an antibiotic with anti-inflammatory properties used to treat infections of the nose and throat. It works on the surface and is applied by a spray. Adverse effects include transient irritation of the nose and throat and allergic reactions. Precautions: Do not use in patients allergic to fusafungine or one of the additives in the spray preparation. Avoid spraying into the eyes. |
| gabapentin |
gabapentin (Neurotin) is an anti-epileptic drug. See Chapter 15. Adverse effects include nausea, vomiting, headache, tremor, fatigue, dizziness, double vision, sleepiness, runny nose, nystagmus (flicking movement of the eyeballs) and loss of control over voluntary movements (ataxia). Precautions: Use with caution in patients with impaired kidney function, in pregnancy, in breastfeeding mothers and in the elderly. Avoid sudden withdrawal, taper the dose off slowly over at least one week. Interactions: Antacids.
|
| galantamine |
galantamine (Reminyl) is an acetylcholinesterase inhibitor used to treat mild to moderately severe Alzheimer's dementia. See Chapter 9. Adverse effects include stomach and bowel upset, fatigue, dizziness, headache, drowsiness, weight loss, confusion, fall, injury, insomnia, inflammation of the lining of the nose, urinary tract infection. Precautions: Do not use in patients with severe liver or kidney damage, intolerance to galactose, disorders of the enzyme lactase, inability to absorb glucose or galactose properly or while breastfeeding. Use with caution in patients with moderate liver damage, heart beat disturbances, history of peptic ulcer, epilepsy, asthma, severe difficulty breathing, stomach, bowel or urinary outflow obstruction, bladder surgery or pregnancy.
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| gallamine |
gallamine (gallamine triethiodide, Flaxedil) is a non-depolarizing muscle relaxant (see p. 39) which is used along with general anaesthetics in surgical operations. It may produce rapid beating of the heart. It should not be used in patients with severe impairment of kidney function because it is excreted via the kidneys.
|
| gamma globulin |
gamma globulin see normal immunoglobulins p. 265.
|
| Gammabulin |
Gammabulin intramuscular injection, see normal immunoglobulin p. 265.
|
| gamolenic acid |
gamolenic acid (gamma-linolenic acid, GLA) is obtained from oil of evening primrose. It is used in Efamast to treat painful breasts (mastalgia) which may be cyclical (e.g. with menstrual periods) or non-cyclical. The discomfort appears to be due to sensitivity to female sex hormones which may be caused by an abnormal ratio of saturated to unsaturated fatty acids in the breast tissue. The pain can be relieved by reducing the ratio of these fatty acids by taking gamolenic acid, which provides a high source of unsaturated fatty acids. It may take up to six months to produce any benefit. Gamolenic acid is also available in Epogam to provide symptomatic relief of eczema. It increases the levels of essential fatty acids in the skin and may help some individuals. Adverse effects include nausea, headache and diarrhoea. Precautions: It should be used with caution in individuals with a history of epilepsy. In women who are treated for mastalgia, cancer of the breast should be excluded before treatment. Use with caution in pregnancy.
|
| ganciclovir |
ganciclovir (Cymevene, Virgon) is an antiviral drug used to treat life-threatening and sight-threatening cytomegalovirus (CMV) infections in patients suffering from AIDS or other immune deficiency disorders and to prevent cytomegalovirus infections in patients during immunosuppressive treatment following organ transplant. Adverse effects include blood disorders, itching, fever, rash and abnormal liver function tests. It may also cause nausea, vomiting, diarrhoea, mouth ulcers, loss of appetite, bleeding in the gut, chest and abdominal pains, chills, generally feeling unwell, fluid retention, changes in blood pressure and heart rate, headache, breathlessness, nervousness, confusion, drowsiness, mental disorders, loss of control over voluntary movements (ataxia), nerve damage, tremor, urinary symptoms, fall in blood sugar level, blood in urine, changes to kidney function, eye pain, deafness, hair loss, acne, sweating, itching, pain and swelling at the injection site and detachment of retina in AIDS patients with inflammation of the retina. Precautions: Do not use in pregnancy and avoid getting pregnant whilst on treatment. Men should use a condom during and for 90 days after treatment has stopped. Do not breastfeed until 72 hours after the last dose. Do not use in patients allergic to ganciclovir or with a low white blood cell count. Blood counts should be carried out every two weeks and if counts for white cells and/or platelets are low the drug should not be given.
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| Ganda |
Ganda eye drops contain varying proportions of guanethidine and adrenaline(epinephrine) for the treatment of glaucoma (see p. 53). Adverse effects include discomfort in the eyes, headache, redness of the eyes and surrounding skin and pigmentation of the eye. General effects from guanethidine and adrenaline(epinephrine) are rare. The drops may cause a rise in pressure inside the eye, drooping of the upper eyelids and damage to the cornea. Precautions: Do not use in patients with closed-angle glaucoma or who have the lens missing from the eye. Examine the conjunctivae and cornea every six months and stop treatment if there are signs of damage.
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| ganglion-blocking drugs |
ganglion-blocking drugs see p. 34.
|
| ganirelix |
ganirelix (Orgalutran) is used to prevent premature luteinsing hormone (LH) surges in women undergoing controlled ovarian stimulation for assisted reproduction. Adverse effects include injection site reactions, headache, nausea. Precautions: Do not use in patients with moderate or severe kidney or liver damage, severe allergic conditions, in pregnancy or while breastfeeding.
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| gargles |
gargles are liquid preparations for washing out the throat, and are usually not intended for swallowing. They are used to treat sore throats but are of doubtful value.
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| garlic |
garlic has been used for its cough expectorant, disinfectant and diuretic properties. There is controversy over claims that garlic helps to lower blood cholesterol and fat levels and reduce the stickiness of blood platelets and may therefore be of benefit in preventing coronary heart disease.
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| gelatin |
gelatin is a protein extracted from animal tissues. It is used in the preparation of capsules, suppositories, pastes, pastilles and pessaries, in preparing lubricating eye drops and to make a solution used to restore blood volume after haemorrhage. It is taken by mouth to treat brittle nails. Allergic reactions have occurred after a slow injection of gelatin.
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| Gelofusine |
Gelofusine is used to increase the volume of the blood. It contains modified gelatin and sodium chloride.
|
| Geltears |
Geltears eye gel contains carbomer 940. It is used to treat dry eye conditions.
|
| gemcitabine |
gemcitabine (Gemzar) is given with cisplatin as a first-line treatment, or alone to relieve the symptoms, of locally advanced or secondary pancreatic cancer; locally advanced or secondary non-small cell lung cancer; cancer of the pancreas not responding to treatment with 5-fluorouracil (5-FU); advanced bladder cancer in combination with cisplatin. See Chapter 51. Adverse effects include mild stomach and bowel side-effects and rashes, kidney damage, damage to the lungs and flu-like symptoms.
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| gemeprost |
gemeprost is a prostaglandin used to soften and dilate the cervix to assist surgical operations through the cervix and during abortions in the first twenty-four weeks of pregnancy. Adverse effects include pain in the womb, bleeding from the vagina, nausea, vomiting, diarrhoea, flushing, backache, dizziness, myasthenia gravis (muscle weakness due to neuromuscular abnormality), headache, breathlessness, chest pain, mild fever and palpitations. Precautions: Do not use in patients allergic to gemeprost or other prostaglandins. Use with caution in patients with obstructive airways disease (e.g. asthma), heart disease, glaucoma or inflammatory conditions of the cervix or vagina, in patients where there is a risk of rupture of the uterus, which is most common in women who have had several babies, a history of surgery on the uterus or if they are also given oxytocic drugs intravenously.
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| gentian mixture, acid |
gentian mixture, acid is a concentrated mixture of gentian infusion, dilute hydrochloric acid and chloroform water. It is used as a bitter to stimulate the appetite.
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| gentian mixture, alkaline |
gentian mixture, alkaline is a concentrated mixture of gentian infusion, sodium bicarbonate and chloroform water. It is used as a bitter to stimulate the appetite.
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| gentian violet |
gentian violet (crystal violet) is used in antiseptic skin applications (see p. 214) against bacteria, worms and fungi.
|
| Germoloids |
Germoloids is a haemorrhoidal preparation containing the local anaesthetic lidocaine(lignocaine) and the soothing agent zinc oxide.
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| gestrinone |
gestrinone (Dimetriose) is used to treat endometriosis. It has both anti-oestrogenic and anti-progestogenic properties. It reduces the secretion of luteinising hormone (LH) and follicle stimulating hormone (FSH) by the pituitary gland and therefore reduces the release of oestrogens and progesterone by the ovaries. It also blocks progesterone receptors in endometrial tissue (i.e. the lining of the womb) and other endometrial deposits, causing them to shrink. It also dries up the menstrual periods. It offers an alternative to danazol and needs to be taken only twice weekly instead of daily. Adverse effects include fluid retention, weight gain, acne, stomach and bowel upsets, changes in appetite, hot flushes, spotting, cramps, nervousness, depression, changes in libido, and, very rarely, male-type hair growth and voice changes. Precautions: It should not be used in women with severe heart, kidney or liver disorders, or when breast feeding. It should not be used in women with diabetes or raised blood cholesterol and fat levels. It should not be used in pregnancy or if there is a risk of the woman being pregnant. Women on treatment should avoid sexual intercourse or use a barrier contraceptive (e.g. condom, cap). Interactions: Anti-epileptic drugs, oral contraceptives and rifampicin. Refer also to entry on danazol.
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| Ginseng |
Ginseng is a plant, various parts of which are used to make medicines. The leaves are used to make tea and are said to help digestion; the roots are used in tonic remedies. There appears to be as many uses as there are preparations available. The most popular types come from China, Manchuria and Korea. If you think it will do you good it probably will, but we need documented scientific evidence if we are to assess its value. Adverse effects include the ginseng abuse syndrome – raised blood pressure, nervousness, sleeplessness, skin rashes and diarrhoea in the mornings.
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| Glandosane |
Glandosane mouth spray contains carboxymethylcellulose sodium, sorbital, potassium chloride, sodium chloride, magnesium chloride, calcium chloride and dipotassium hydrogen phosphate. It is used to treat dry mouth associated with radio-therapy and the use of antimuscarinic drugs.
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| glantiramer |
glantiramer (Copaxone) is used in relapsing-remitting multiple sclerosis to reduce the frequency of relapses in patients who are able to walk and who have had at least one relapse during the previous 2 years. Adverse effects include immediate post-injection reactions (such as dilation of the blood vessels), chest pain, difficulty breathing, palpitations, rapid heart beat, injection site reactions, weakness, nausea, hypertonia (abnormally high muscle tone), headache, pain in joints, rash, sweating, enlargement of the lymph nodes, tremor, fluid retention, fainting. Precautions: Do not use in patients who are allergic to mannitol. Use with caution in the elderly, in patients with kidney damage, a history of cardiovascular disease, in pregnancy or who are breastfeeding.
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| glimepiride |
glimepiride (Amaryl) is used to treat non-insulin dependent (type II) diabetes. See Chapter 42. Adverse effects include low blood glucose level (hypoglycaemia), allergic reactions including skin rash, stomach and bowel upsets, abdominal pain, confusion, dizziness, drowsiness, headache, generally feeling unwell, tremor, visual disturbances, liver disorders, blood disorders, raised liver enzymes. Precautions: Do not use in patients with juvenile growth-onset or unstable brittle diabetes, an increase in the level of ketones in the blood, severe kidney or liver damage, endocrine disorders, stress, infections, after surgical procedures, in pregnancy or while breastfeeding. Use with caution in the elderly or in patients with kidney failure.
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| glucagon |
glucagon is a hormone produced by the pancreas that stimulates the release of glucose from glucose stores in the liver. It is used in the emergency treatment of hypoglycaemia (low blood sugar) in insulin-dependent diabetic patients. Unlike glucose it can be injected under the skin or into a muscle as well as into a vein. Adverse effects include nausea, vomiting, diarrhoea and low blood potassium. Allergic reactions occurred occasionally with glucagon which was obtained from the pancreatic glands of pigs and cows. A genetically engineered glucagon (Glucagen) has now replaced it. Precautions: It should not be used in patients with a phaeochromocytoma (tumour of the sympathetic nervous system), insulin or glucagon producing tumours. It should be used with caution in pregnancy and breastfeeding mothers.
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| glucocorticoids |
glucocorticoids see Chapter 37.
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| glucocorticosteroids |
glucocorticosteroids see Chapter 37.
|
| glutaraldehyde |
glutaraldehyde (Glutarol) is used as a gel or liquid in the treatment of warts (see p. 231). Adverse effects: It may irritate and stain healthy skin brown. Precautions: Do not use on facial warts or ano-genital warts. Avoid contact with healthy skin.
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| glycerol |
glycerol (glycerin or glycerine) is used as a sweetening agent in mixtures, linctuses and pastilles. Externally, it is used in creams for its water-retaining and skin softening properties. It is used in Audax ear drops to soften wax, in Micollette and Relaxit micro-enemas. Glycerol (glycerin) suppositories are used to treat constipation. See Chapter 21. Referred to as glycerin in Exterol ear drops and in Massé cream used to treat sore nipples. It is used to sooth the throat in some cough medicines. Adverse effects and Precautions: By mouth glycerol may cause headaches, thirst, nausea, diarrhoea, and a rise in blood sugar levels. Rarely it may cause disorders of heart rhythm and coma. Large doses by injection may damage red blood cells and the kidneys. Use with utmost caution in diabetic patients and patients who are dehydrated.
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| glyceryl trinitrate |
glyceryl trinitrate (nitroglycerin, trinitrin) is a nitrate vasodilator used to treat angina (see Chapter 22) and heart failure (see Chapter 23). For preparations, see p. 97. It may also be used by injection to relieve pain from kidney stones or gallstones. Adverse effects include flushing of the face, rapid beating of the heart, severe throbbing headache, faintness, and dizziness, especially on standing up after sitting or lying down due to a fall in blood pressure (postural hypotension). Overdose may cause restlessness, vomiting, fall in blood pressure and faintness, but these only last for a short time. Rapid intravenous injection can cause a fall in blood pressure, nausea, retching, apprehension, restlessness, muscle twitching, abdominal pains and fainting. Precautions: Glyceryl trinitrate should not be used in patients sensitive to nitrates, who have narrowed aortic or mitral valves of the heart (aortic stenosis, mitral stenosis) or certain other heart disorders, in patients with anaemia, head injury, brain haemorrhage or closed-angle glaucoma. It should be used with caution if blood pressure is low (do not use intravenously), in patients with severe impairment of kidney or liver function, underworking of the thyroid gland, malnutrition or recent heart attack. Tolerance to its effects can occur. See p. 98.
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| gonadorelin |
gonadorelin (GnRH, LH-RH, HRF) is gonadotrophin-releasing hormone. It stimulates the pituitary gland to secrete LH and FSH (see Chapter 40). When injected intravenously it leads to a rapid rise in plasma-luteinizing hormone (LH) and follicle-stimulating hormone (FSH) concentrations. It is used to treat absence of periods and to treat certain types of infertility, particularly in females. Adverse effects include nausea, headaches, abdominal pain and increased menstrual bleeding. Allergic reactions may rarely occur after repeated injections. Pain at the injection site may occur. Precautions: Do not use in patients with cysts of the womb or polycystic disease of the ovaries. Do not use to treat loss of periods due to loss of weight (e.g. anorexia nervosa) before weight is put back on (because periods should return without drug treatment). Stop if conception occurs or after six months of treatment. It is also used to assess the function of the pituitary gland.
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| goserelin |
goserelin (Zoladex) mimics the action of the gonadotrophin releasing hormone which stimulates the pituitary gland to release luteinizing hormone (LH). In men it stimulates the testes to produce the male sex hormone, testosterone. After initial stimulation it leads to a reduction in testosterone production by the testes equivalent to castration. It is used to treat cancers of the prostate gland which are dependent on testosterone for growth. In women treatment with goserelin switches off the production of female sex hormones by the ovaries which is of benefit to women suffering from endometriosis or advanced cancer of the breast in pre-menopausal and peri-menopausal women. It is also used to thin the lining of the womb before a scrape. Adverse effects in women include breakthrough bleeding, menopausal-type symptoms such as hot flushes, palpitations, increased sweating, vaginal dryness and changes in libido. It may cause headache, nausea, mood changes, breast swelling and tenderness, abdominal pain, fatigue, weight changes, dizziness, drowsiness, nervousness, acne, backache, muscle pains, ovarian cysts, reduced bone density, allergic rashes, itching, white vaginal discharge, blurred vision, changes in body hair and a rise in blood calcium levels in women being treated for breast cancer. Adverse effects in men treated for prostate cancer include an increase in bone pain from secondaries (due to the initial rise in testosterone), hot flushes, decreased libido, depression, headache, nausea, vomiting, dizziness, swelling of the breasts and allergic skin rashes. Precautions in women: Do not use in breastfeeding mothers or in pregnancy. While on treatment use nonhormonal method of contraception. Do not use in women with undiagnosed vaginal bleeding. Use with caution to treat endometriosis in women at risk of developing osteoporosis. Precautions in men: There is a risk of calcium stones blocking the outlet from the kidneys (ureters) and compression of the spinal cord – monitor carefully for the first four weeks whilst testosterone levels are high. May have to use an anti-androgen drug.
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| gramicidin |
gramicidin is an antibiotic used in skin, ear and eye applications. It is too toxic to be given by mouth or injection. It is included in Adcortyl with Graneodin, in Graneodin, Neosporin, Sofradex, Soframycin, Tri-Adcortyl and Tri-Adcortyl-Otic.
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| Graneodin |
Graneodin applications contain the aminoglycosides neomycin and gramicidin. They are used to treat infections of the skin. Adverse effects include allergic reactions, damage to the kidneys and to hearing. Precautions: Do not use as dressings or apply to large areas of damaged skin and do not use in the ear in patients with a perforated ear drum. Do not use to treat viral or fungal infections of the skin or to treat deep-seated infections.
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| granisetron |
granisetron (Kytril) is a 5TH3 blocker used to prevent and treat nausea and vomiting caused by anti-cancer drugs and post-operative nausea and vomiting. See Chapter 18. Adverse effects include skin rashes, headache, constipation and changes in liver function tests. Precautions: Do not use in breastfeeding mothers. Use with caution in pregnancy and in patients with partial obstruction of the intestine.
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| granulocyte-colony stimulating factor |
granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of granulocytes (white blood cells) and may reduce the duration of a fall in neutrophil production by the bonemarrow, in patients undergoing chemotherapy. Since neutrophils fight infection this is important in reducing the risks from infection in these patients. Preparations include filgrastim and lenograstim. Malgramostim is a recombinant granulocyte macrophage-colony stimulating factor which stimulates production of all granulocytes and monocytes.
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| griseofulvin |
griseofulvin (Grisovin) is an anti-fungal antibiotic (see Chapter 47) used to treat fungus infections of the nails, hair and skin. Adverse effects include drowsiness, headaches, allergic reactions, blood disorders, skin sensitivity to sunlight, depression, nausea, vomiting, confusion, dizziness and fatigue. May aggravate or trigger systemic lupus erythematosis (SLE - a disease of unknown cause with symptoms of fever, muscle and joint pain, blood disorders and skin eruptions). Precautions: Griseofulvin should not be used in patients suffering from porphyria (a hereditary disorder of metabolism) or severe liver disease. It should not be used in pregnancy. Men should not father a child during and within six months of stopping treatment. It may impair the ability to drive. Interactions: Alcohol, coumarin anti-coagulants, barbiturates, oral contraceptives.
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| growth hormone |
growth hormone is a hormone produced by the pituitary gland that stimulates and controls growth of tissues and various metabolic processes in the body. Somatropin is a synthetic human growth hormone produced by DNA bio-technology. It is identical to natural growth hormone. It is used to produce growth in children who are not producing sufficient of their own growth hormone to enable them to grow naturally. It is also used to treat patients with Turner’s Syndrome and to treat growth disturbances in pre-pubital children with chronic impairment of kidney function and as replacement therapy in adults with evidence of growth hormone deficiency. Preparations include Genotropin, Humatrope, Norditropin and Saizen. Adverse effects: Injections may cause pain and damage the fat under the skin, causing dents (lipoatrophy). Fluid retention may occur (e.g. swelling of the ankles) and the thyroid gland may become under-active. It may cause headache, raised blood sugar, sugar in the urine, muscle pain and weakness. Precautions: Do not use once bone growth has stopped, in patients with an active tumour, in pregnancy or in breastfeeding mothers. Use with caution in patients with diabetes or adrenocorticotropic hormone (ACTH) deficiency. Thyroid function tests should be carried out at regular intervals.
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| guaifenesin |
guaifenesin reduces the stickiness of sputum and is used as a cough expectorant. See Chapter 11.
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| guar gum |
guar gum (Guarem) is used as a thickening agent in medicines. Also as an additional treatment in patients with diabetes in order to reduce the rise in blood sugar level that occurs after meals. It may slow down the absorption of carbohydrates. It is also used to relieve dumping syndrome (full stomach, nausea, weakness, sweating, palpitations and diarrhoea after a meal) and as a bulking agent to help slimming diets (see p. 30). Adverse effects include wind and distension of the abdomen. Precautions: Do not use in patients with obstructive disease of the oesophagus, stomach or intestine. Diabetic patients should have their blood sugar levels monitored during initial treatment and their anti-diabetic treatment may need to be changed. Guar gum should be taken with a large drink of water and not just before going to bed.
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| GyneFix |
GyneFix is a contraceptive intrauterine device containing copper.
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| Gynol II |
Gynol II is a spermicidal contraceptive gel containing nonoxinol 9.
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| H2 receptor blockers |
H2 receptor blockers see Chapter 19.
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| haem arginate |
haem arginate (Normosang) is used to treat acute liver porphyria (a hereditary disorder of metabolism). Adverse effects include thrombophlebitis (inflammation in a vein), fever, allergic reactions. Precautions: Use with caution in pregnancy or while breastfeeding.
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| haemostatics |
haemostatics stop bleeding see p. 124.
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| halcinonide |
halcinonide (Halciderm cream) is a very potent corticosteroid used to treat eczema and psoriasis. Adverse effects and Precautions see corticosteroid skin applications p. 211. Do not dilute. Monitor patients with psoriasis to ensure cream is effective.
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| halibut liver oil |
halibut liver oil is a rich source of fish oils and vitamins A and D.
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| haloperidol |
haloperidol (Dozic, Haldol, Serenace) is used for schizophrenia, psychosis, mania, hypomania, behavioural disorders, dangerously impulsive behaviour, intractable hiccup, agitation in the elderly, severe tics. See Chapter 3. Adverse effects include lack of muscle tone, loss of perception of movement, parkinsonism-like syndrome, slowness of movement, dry mouth, nasal stuffiness, difficulty in urination, rapid heart beat, constipation, blurring of vision, low blood pressure, weight gain, impotence, excessive or spontaneous flow of milk, low body temperature, development of breasts in males. Precautions: Do not use in patients in comatose states, with depression, Parkinson's disease, lesions of the basal ganglia. Use with caution in patients with liver or kidney failure, epilepsy, disturbed thyroid function, phaeochromocytoma (a tumour of the sympathetic nervous system), severe heart disease, potassium deficiency in the blood, abnormal ECG, in pregnancy or while breastfeeding.
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| halothane |
halothane is a general anaesthetic which may cause liver damage.
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| Harvix |
Harvix is a hepatitis A vaccine.
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| HB-Vax II |
HB-Vax II is a hepatitis B vaccine.
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| Hep-flush |
Hep-flush contains heparin. It is used for cleaning out and removing blood clots from injection tubes. It is not for administration to humans.
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| heparin |
heparin prevents the blood from clotting. See Chapter 28. It is ineffective by mouth and must be given by injection. Adverse effects: The main adverse effect is bleeding – from any site. Rarely, fever and allergic reactions may occur. Nosebleeds, red blood cells in the urine and bruising are the signs of overdosage. Temporary loss of hair, damage to the skin (necrosis) and diarrhoea may occur. Osteoporosis may occur after prolonged use. Heparin may cause a fall in blood platelets (thrombocytopenia) producing bleeding into the skin and lining of the mouth, etc. Precautions: It should not be used in patients with bleeding disorders (e.g. haemophilia), peptic ulcers, allergy to heparin, recent brain haemorrhage, severely raised blood pressure, severe kidney or liver disease, or after recent surgery on the eye or nervous system. Blood platelet counts should be carried out at regular intervals on patients receiving heparin for longer than five days and treatment should be stopped immediately if there is a fall in blood platelets.
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| heparinoid |
heparinoid is a derivative of heparin. It has anti-inflammatory and anti-clotting actions and reduces the amount of exudate. It is used in Hirudoid and Lasonil applications to relieve bruises, sprains, soft-tissue injuries, and bruising around varicose veins. It should not be used on open wounds or on mucous membranes e.g. the lining of the mouth or vagina. It is also used in Anacal cream to treat haemorrhoids.
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| Hepatyrix |
Hepatyrix is a hepatitis A vaccine.
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| Heplok |
Heplok contains heparin. It is used for cleaning out and removing blood clots from injection tubes. It is not for administration to humans.
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| Hepsal |
Hepsal contains heparin. It is used for cleaning out and removing blood clots from injection tubes. It is not for administration to humans.
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| hexachlorophene |
hexachlorophene (Ster-Zac DC, Ster-Zac Powder) is an antiseptic and disinfectant, see p. 214. Adverse effects: Sufficient may be absorbed through damaged skin or burns to cause stimulation of the brain, leading to convulsions. It may also be absorbed through the skin of newborn babies and damage the brain. It may cause allergic reactions on the skin and also sensitize the skin to the sun’s rays. Precautions: It should not be used on large areas of skin, on damaged or burnt skin, in the mouth, in the vagina, or under non-permeable dressings. It should not be used in pregnancy or in children under two years of age. Blood reduces its effectiveness. Preparations of hexochlorophane may become infected with gram-negative bacteria.
|
| hexetidine |
hexetidine has an antiseptic action and is used in Oraldene solution as a mouth-wash and gargle. It may cause stinging.
|
| HibTITER |
HibTITER is a haemophilus influenzae type B vaccine.
|
| histamine |
histamine see Chapter 27.
|
| Histamine H2-blockers |
Histamine H2-blockers see H2 receptor blockers in Chapter 19.
|
| HNIG |
HNIG see normal immunoglobulins p. 265.
|
| hormone blockers |
hormone blockers: See anti-androgens, p. 164, and anti-oestrogens, p. 172.
|
| Humaject |
Humaject is an insulin preparation. See Chapter 42.
|
| Humaject-M |
Humaject-M is an insulin preparation. See Chapter 42.
|
| Humalin Lente |
Humalin Lente is an insulin preparation. See Chapter 42.
|
| Humalog |
Humalog is an insulin preparation. See Chapter 42.
|
| Human Actrapid |
Human Actrapid is an insulin preparation. See Chapter 42.
|
| Human Insulatard |
Human Insulatard is an insulin preparation. See Chapter 42.
|
| human insulins |
human insulins, see Chapter 42 on insulins.
|
| Human Mixtard |
Human Mixtard is an insulin preparation. See Chapter 42.
|
| Human Monotard |
Human Monotard is an insulin preparation. See Chapter 42. |
| Human Normal Immunoglobulin |
Human Normal Immunoglobulin is an insulin preparation. See Chapter 42.
|
| Human Ultratard |
Human Ultratard is an insulin preparation. See Chapter 42.
|
| Human Velosulin |
Human Velosulin is an insulin preparation. See Chapter 42.
|
| HumaPen |
HumaPen is an insulin preparation. See Chapter 42.
|
| Humulin I |
Humulin I is an insulin preparation. See Chapter 42.
|
| Humulin I Pen |
Humulin I Pen is an insulin preparation. See Chapter 42.
|
| Humulin M |
Humulin M is an insulin preparation. See Chapter 42.
|
| Humulin S |
Humulin S is an insulin preparation. See Chapter 42.
|
| Humulin Zn |
Humulin Zn is an insulin preparation. See Chapter 42.
|
| hyaluronidase |
hyaluronidase (Hyalase) is an enzyme from mammals’ semen which makes tissues more permeable. It is used to increase the spread and absorption of drugs from injections, e.g. local anaesthetics and subcutaneous injections. It is also used in Lasonil ointment to help the resorption of fluid and blood under the skin e.g. a swollen bruise. Adverse effects: It may rarely produce a severe allergic reaction. Precautions: Do not apply directly to the cornea or to infected cancerous lesions. Do not use to treat insect bites or stings. Do not use intravenously. Use with caution in infants and the elderly – control speed and volume used (especially if patient has impaired kidney function).
|
| Hyate-C |
Hyate-C is a porcine preparation of antihaemophilic factor for individuals who develop inhibitors to human factor VIII which is used to control bleeding in patients suffering from haemophilia A.
|
| hydralazine |
hydralazine (hydralazine hydrochloride, Apresoline) is a vasodilator used to treat raised blood pressure, see Chapter 25, and heart failure, see Chapter 23. Adverse effects include nausea, vomiting, headache, a fall in blood pressure on standing, rapid beating of the heart, flushing, fluid retention, sweating, breathlessness, skin rashes, difficulty in passing water and depressed mood. These usually occur in the first few weeks of treatment. Very rarely it may cause kidney damage, blood disorders and nerve damage (e.g. pins and needles in the arms and legs). Prolonged use of high doses may, rarely, cause skin disorders. Precautions: It should not be used in patients with rapid beating of the heart or narrowing of the aortic or mitral valves, or in the first half of pregnancy. It should be used with caution in patients with diseases of the arteries in the brain or heart, severe kidney failure, impaired liver function, or in breastfeeding mothers. Interactions: Tricyclic antidepressants, MAOIs, sleeping drugs, sedatives, anaesthetics, anti-blood pressure drugs, diazoxide.
|
| hydrocortisone |
hydrocortisone is a corticosteroid that is included in many skin preparations. See Chapter 37 on corticosteroids and corticosteroid skin applications, p. 211.
|
| hydrocortisone-17-butyrate |
hydrocortisone-17-butyrate is a potent form of hydrocortisone used in skin preparations (Locoid) to treat severely inflamed skin disorders such as eczemas that have not responded to less potent corticosteroids. See Chapter 37 on corticosteroids and corticosteroid skin applications p. 211.
|
| hydrogen peroxide |
hydrogen peroxide is used as an antiseptic and deodorant, to clean wounds, as a mouthwash and to remove ear wax. Avoid contact with normal skin and use with utmost caution on large or deep wounds. It may bleach fabrics. It is present in Hioxyl cream for cleaning leg ulcers and pressure sores, in Exterol and Otex ear drops to remove wax and in hydrogen peroxide mouthwash (Peroxyl).
|
| hydromorphine |
hydromorphine (Palladone) is used for relief of severe pain in cancer. See Chapter 30. Adverse effects include constipation, nausea, vomiting, drowsiness. Precautions: Do not use in patients with respiratory depression, coma, paralysis of the small intestine, liver damage, raised pressure in the brain or convulsions.
|
| hydroxocobalamin |
hydroxocobalamin (vitamin B12, Cobalin-H, Neo-Cytamen) is used to treat pernicious anaemia and other B12 deficient anaemias. It may very rarely cause allergic reactions. See Chaspter 36.
|
| hydroxyapatite |
hydroxyapatite (Ossopan) is used to provide calcium and phosphorous in the treatment of osteoporosis, rickets and during breast feeding. Precautions: It should not be used in patients with a raised level of calcium in their blood or urine. It should be used with caution in patients with a history of kidney stones, impaired kidney function or if the patient is very immobilized.
|
| hydroxycarbamide(hydroxyurea) |
hydroxycarbamide(hydroxyurea) (Hydrea) is an anti-cancer drug. See Chapter 51. It is used mainly to treat chronic myeloid leukaemia. Adverse effects: It may damage the bone marrow, producing blood disorders. Rarely, it may cause nausea, vomiting, skin rashes, loss of hair, abdominal pain, diarrhoea, blood in the motions and kidney damage. Precautions: It should not be used in pregnancy or in patients with severe blood disorders.
|
| hydroxychloroquine |
hydroxychloroquine (hydroxychloroquine sulphate, Plaquenil) is an antimalarial drug. It has effects and uses similar to those described under chloroquine. It is also used in high doses to treat rheumatoid arthritis (see Chapter 32), certain skin disorders and skin disorders made worse by exposure to the sun’s rays. Adverse effects and Precautions: These are similar to those listed under chloroquine.
|
| hydroxyquinolone |
hydroxyquinolone (in Quinocort) is used as an anti-bacterial and antifungal in skin applications. It is also used for removing dead skin and as a deodorant.
|
| hydroxyzine |
hydroxyzine (hydroxyzine embonate, hydroxyzine hydrochloride, Atarax, Ucerax) is an antihistamine drug (see Chapter 17) used to treat anxiety (see Chapter 2). It is also used to treat generalized itching, see p. 216. Adverse effects include drowsiness, headache, dizziness, weakness, confusion and dry mouth. High doses may produce involuntary movements. Precautions: Do not use in pregnancy and use with caution if kidney function is impaired. Interactions: It increases the effects of alcohol and other depressant drugs. It may affect ability to drive motor vehicles or operate moving machinery.
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| Hypericum |
Hypericum see Chapter 4 |
| hypnotics |
hypnotics (sleeping drugs), see Chapter 1. |
| Hypostop gel |
Hypostop gel is a glucose preparation taken orally for the treatment of hypoglycaemia.
|
| hypromellose |
hypromellose has effects and uses similar to those produced by methylcellulose. It is mainly used as eye drops, for artificial tears, e.g. Isopto Alkaline, Isopto Naturale, in Tears Naturale.
|
| Hypurin 30/70 |
Hypurin 30/70 is an insulin preparation. See Chapter 42.
|
| Hypurin Isophane |
Hypurin Isophane is an insulin preparation. See Chapter 42.
|
| Hypurin Lente |
Hypurin Lente is an insulin preparation. See Chapter 42.
|
| Hypurin Neutral |
Hypurin Neutral is an insulin preparation. See Chapter 42.
|
| Hypurin Protamine Zinc |
Hypurin Protamine Zinc is an insulin preparation. See Chapter 42.
|
| ichthamol |
ichthamol is a reddish brown to black sticky liquid obtained from the distillation of bituminous shale. It is slightly antibacterial. It may irritate the skin and rarely produce an allergic reaction. It is used in creams, ointments and bandages, often with zinc oxide, to treat skin disorders e.g. eczema.
|
| idarubicin |
idarubicin (Zavedos) is an anti-cancer drug related to daunorubicin. See Chapter 51. It is a cytotoxic antibiotic. Adverse effects include damage to the bone marrow (producing blood disorders), nausea, vomiting, diarrhoea, sore mouth and oesophagus, fever, chills and skin rashes. It may affect liver function, cause reversible hair loss and discoloration of the urine. Very rarely, the patient may develop very severe infections and damage to the heart. Precautions: It should not be used in individuals with severe impairment of liver or kidney function, or uncontrolled infections, or in women who are breastfeeding. It should be used with caution in people with impaired bone-marrow function, with heart disease or who have received similar drugs in high doses. Patients over fifty-five years of age will need special care during the period when the bone marrow is not working. Uric acid levels should be checked at intervals. Any infection should be treated before treatment starts. Leakage at the site of infection may cause inflammation of the vein. It may irritate the skin and should be handled with caution.
|
| idoxuridine |
idoxuridine (in Herpid) is an antiviral drug that is used topically to treat herpes zoster infections (shingles) and herpes simplex infections (e.g. cold sores) of the skin. See Chapter 48. Adverse effects and Precautions: It should not be used in pregnancy and in breastfeeding mothers. Skin applications may cause stinging and should not be applied near the eyes or mouth. They may stain the clothing.
|
| imidapril |
imidapril (Tanatril) is used to treat high blood pressure. See Chapter 25. Adverse effects include cough, dizziness, fatigue, stomach and bowel upset, angioedema (allergic swelling of the mouth and throat), severely low blood pressure, kidney failure, allergic reactions. Precautions: Do not use in patients with a history of angioedema due to previous ACE inhibitor therapy, heredity or from an unknown cause, high blood pressure, kidney failure with or without blood dialysis, pregnancy or while breastfeeding. Use with caution in patients with a risk of severe low blood pressure (through loss of blood or fluids, sodium deficiency in the blood or heart failure), kidney or liver damage, narrowing of the main artery from the heart (aortic stenosis), hypertrophic cardiomyopathy (enlargement of the muscles of the heart), psoriasis, in surgery, blood dialysis or apheresis (a certain form of blood donation) with high flux membranes.
|
| imidazole antifungal drugs |
imidazole antifungal drugs, see Chapter 47.
|
| imiglucerase |
imiglucerase (Cerezym) is an enzyme administered as replacement therapy in Gaucher’s disease which is a hereditary disorder affecting principally the liver, spleen, bone marrow and lymph nodes. Adverse effects include itching, pain, swelling or sterile abscesses at injection site, allergic reactions, nausea, vomiting, diarrhoea, abdominal pain, fatigue, headache, dizziness, fever, rash. Precautions: Do not use in pregnancy or while breastfeeding.
|
| imipenem |
imipenem is a broad spectrum antibiotic. See Chapter 46. Because imipenem is partially inactivated by an enzyme in the kidney it is combined in Primaxin with cilastatin, which blocks that enzyme. Adverse effects include nausea, vomiting and diarrhoea (colitis may occur rarely), blood disorders and allergic reactions (itching, rash, nettle-rash, fever). Rarely, muscle twitching, convulsions, confusion and mental disturbances may occur with very high doses or in patients with impaired kidney function. It may produce pain, redness and swelling, and inflammation at the site of injection. It may produce changes in biochemical tests of liver and kidney function. It may make the urine red in children. Precautions: Do not use in patients who are allergic to imipenem or cilastatin. Use with caution in pregnancy, in breastfeeding mothers, in patients known to be allergic to penicillins, cephalosporins or other beta-lactam antibiotics, in patients with impaired kidney function, epilepsy, disorders of the central nervous system, or colitis. Interactions: Probenecid, ganciclovir.
|
| imiquimod |
imiquimod (Aldara) is used to treat warts on the genitals and around the anus. See Chapter 45. Adverse effects include skin reactions where it is applied. Precautions: Uncircumsised men with warts under foreskin should wash area daily. Avoid open wounds, do not use non-permeable dressings. Use with caution in the elderly, in pregnancy or while breastfeeding.
|
| Immune interferon |
Immune interferon see Chapter 51.
|
| Immunisations |
Immunisations see Chapter 53.
|
| immunosuppressants |
immunosuppressants see Chapter 17.
|
| Imuderm |
Imuderm is a skin softening bath additive containing almond oil and light liquid paraffin. It is used to treat dry skin conditions including dermatitis, eczema, pruritus and ichthyosis.
|
| indapamide |
indapamide (Natrilix, Nindaxa, Opumide, Natramid) is a thiazide-like diuretic (see Chapter 29) used to treat raised blood pressure (see Chapter 25). Adverse effects include headaches, dizziness, fatigue, loss of appetite, indigestion, nausea, diarrhoea, constipation, muscle cramps and fall in blood potassium levels. Rarely it may cause rashes (sometimes severe), fall in blood pressure on standing up after sitting or lying down, rise in blood sugar and blood uric acid levels, pins and needles, sensitivity of the skin to the sun’s rays, impaired kidney function, impotence and reversible short-sightedness. Precautions: Do not use in patients who have had a recent stroke or who have severe impairment of liver function or who are breast feeding. Use with caution in patients with impaired kidney function (stop if it gets worse), over-active parathyroid glands, gout or in pregnancy. Use with caution in the elderly and monitor blood chemistry. Interactions: Diuretics, anti-arrhythmic drugs, digoxin and related drugs, corticosteroids, laxatives, lithium.
|
| indinavir |
indinavir (Crixivan) is an anti-viral drug used to treat patients suffering from HIV infection. See Chapter 48. Adverse effects include stomach and bowel upsets, fatigue, dizziness, headache, weakness, insomnia, dry mouth, pins and needles, painful muscles, skin rashes, disturbances of taste, pain on passing urine, kidney stones and changes in blood chemistry. Precautions: Do not use in breast-feeding mothers. Use with caution in patients suffering from impaired liver function, haemophilia and in pregnancy. Use with caution in patients with kidney stones and make sure they drink plenty of fluids. Interactions: Alprazolam, astemizole, methadone, phenobarbitone, phenytoin, rifabutin, rifampicin, terfenadine, triazolam.
|
| indoramin |
indoramin is a selective alpha1-blocker used as Baratol to treat raised blood pressure. See Chapter 25. It is also used as Doralese to relax smooth muscles in benign enlargement of the prostate gland in order to improve the passing of urine (see p. 251). Adverse effects include sedation, weakness, drowsiness, headache, palpitations, fall in blood pressure (especially on standing), rapid heart beat, dry mouth, nasal congestion, weight gain, dizziness, depression and failure to ejaculate. Precautions: Do not use in patients with heart failure. Drowsiness may occur in the first few days of treatment and patients should be warned not to drive motor vehicles or operate moving machinery. It should be used with caution in patients with impaired kidney or liver function or in patients with epilepsy, depression or parkinsonism. Impaired heart function should be treated with digoxin and a diuretic. Interactions: MAOIs, other anti-blood pressure drugs.
|
| Infanrix |
Infanrix is a triple vaccine containing diptheria, tetanus and pertussis vaccine.
|
| Infanrix-Hib |
Infanrix-Hib is infanrix vaccine, see above, with haemophulus influenza vaccine added.
|
| infliximab |
infliximab (Remicade) is used to treat severe active Crohn's disease (chronic diarrhoeal disorder) or fistulising Crohn's disease in patients unresponsive to corticosteroid and/or immunosuppresant therapy. See Chapter 17. Adverse effects include viral infection, fever, headache, vertigo, dizziness, high blood pressure, flushing, urinary tract infections, upper or lower respiratory tract infection, difficulty breathing, sinusitis, stomach and bowel upset, skin reactions, fatigue, chest pain. Precautions: Do not use in patients with infections or abscesses, allergy to murine proteins, in pregnancy (ensure adequate contraception) or while breastfeeding within 6 months of dose. Use with caution in patients with liver or kidney damage, or in the elderly.
|
| Influvac |
Influvac is influenza vaccine.
|
| inosine pranobex |
inosine pranobex (Imunovir) is used as an antiviral drug by mouth to treat herpes simplex infections and genital herpes. It is also used to treat a viral brain infection (subacute sclerosing panecephalitis). Adverse effects: It may cause a rise in uric acid levels in the blood and urine. Precautions: It should be used with caution in patients with impaired kidney function, gout or raised blood uric acid level. See Chapter 48.
|
| inotropic drugs |
inotropic drugs have a positive action in strengthening the muscular contractions of the heart e.g. digoxin.
|
| insulins |
insulins see Chapter 42.
|
| Insuman Basal |
Insuman Basal is an insulin preparation, see Chapter 42.
|
| Insuman Comb |
Insuman Comb is an insulin preparation, see Chapter 42.
|
| Insuman Rapid |
Insuman Rapid is an insulin preparation, see Chapter 42.
|
| Interferon beta |
Interferon beta (Avonex, Betaferon, Rebif) see Chapter 51.
|
| interferon gamma-1b |
interferon gamma-1b (immune interferon, Immukin) is an interferon, see p. 257. It is used with antibiotics to reduce the frequency of serious infections occurring in patients with chronic granulomatous disease which is an inherited disease that weakens the ability of white blood cells to kill invading bacteria. Adverse effects include nausea, vomiting, headache, fever, chills, muscle and joint pains, fatigue and rashes. Precautions: Use with utmost caution in patients with severe impairment of liver or kidney function or heart disease. Blood counts, urine tests, blood chemistry tests and liver and kidney function tests should be carried out at regular intervals. It may impair ability to drive or operate machinery. Adverse effects may be increased by alcohol.
|
| Interferons |
Interferons see Chapter 51.
|
| Iocare |
Iocare eye irrigation solution contains salts of sodium, calcium and potassium. It is used during eye surgery.
|
| iodine |
iodine and its salts (iodides) in various forms are used as disinfectants and antiseptics (see p. 214). They are also used to treat overworking of the thyroid gland (see Chapter 43) and in some cough medicines. See Chapter 11. Adverse effects: Iodine and iodides may cause the thyroid gland to underwork producing goitre (see Chapter 45). This may also occur in infants born to mothers who took iodine or iodides during pregnancy. Iodine preparations can cause allergic reactions whether taken by mouth or applied to the skin. These reactions include nettle rash (urticaria), angioedema (allergic swelling of the mouth and throat), fever, painful joints, swollen glands and a rise in white blood cells (oesinophils). Prolonged use can cause iodism – metallic taste in the mouth, increased salivation, burning sensation in the mouth, running nose, a swollen, sore throat and swelling and irritation of the eyes. An acne-like rash, fluid on the lungs (pulmonary oedema) and stomach and bowel upset may occur. Precautions: Do not use in patients with a history of allergy to iodine or iodides. Do not take regularly during pregnancy or when breast feeding. Do not cover iodine or iodide skin applications with a non-permeable dressing. Iodine preparations may interfere with laboratory tests of thyroid function. The use of cough medicines that contain iodine or iodides should be limited, they should not be used in pregnancy and preferably not when breast feeding. They should not be used in adolescents because of the risk of acne and their effects on the thyroid gland and they should not be used in patients with goitre. Do not apply iodine or iodide containing preparations to severe burns or large areas of the skin, they may cause iodine adverse effects (see above) and interfere with thyroid function.
|
| iodine, radioactive |
iodine, radioactive, is used to treat over-active thyroids. See Chapter 43.
|
| ipecacuanha |
ipecacuanha (the dried roots of Cephaelis ipecacuanha) in very small doses is used as a cough expectorant. See Chapter 11. It is also used to produce vomiting after swallowing certain poisons. Adverse effects: Ipecacuanha has an irritant effect upon the stomach and intestine. Large doses produce vomiting and diarrhoea, and sometimes bleeding from the stomach or intestine. Regular misuse (e.g. to lose weight) may damage the heart muscle and kidneys and may cause death.
|
| irbesartan |
irbesartan (Aprovel, in Co-Approvel) is used to treat high blood pressure. See Chapter 25. Adverse effects include dizziness, musculoskeletal pain, flushing, allergic reactions. Precautions: Do not use in pregnancy or while breastfeeding. Use with caution in patients with high blood pressure, kidney or liver damage, heart failure, narrowing of the mitral valve or of the main artery (aorta) from the heart, obstructive hypertropic cardiomyopathy (enlargement of the heart due to muscle damage), blood dialysis.
|
| irinotecan |
irinotecan (Campto) is used in combination with 5-fluorouracil (5-FU) and folinic acid for the first-line treatment of advanced bowel cancer and treatment of secondary bowel cancer that has failed to respond to a therapy containing 5-fluorouracil (5-FU). See Chapter 51. Adverse effects include delayed diarrhoea, decrease in certain kinds of white blood cells, anaemia, decrease in number of platelets in the blood, liver damage, nausea, vomiting, acute cholinergic syndrome, weakness, hair loss, difficulty breathing, cramps, abnormal sensations such as tingling, burning or tightness. Precautions: Do not use in patients with chronic inflammatory bowel disease, bowel obstruction, liver or kidney damage, suppression of blood cell production, in pregnancy or while breastfeeding.
|
| iron |
iron is an essential element in the body. It is discussed in Chapter 35. Iron preparations are used to treat and prevent iron deficiency anaemia, see Chapter 35. Preparations of iron salts are taken by mouth, usually as ferrous salts. Iron may also be given by intramuscular or intravenous injection, Adverse effects: Iron salts are astringent and they may irritate the stomach lining, producing nausea and pains in the stomach. They may also cause constipation and diarrhoea. These symptoms are related to the amount of elemental iron in the preparation. Iron salts may colour the stools black. Oral iron, particularly modified release preparations, may make diarrhoea worse in patients suffering from chronic inflammatory diarrhoeal disorders such as ulcerative colitis or Crohn’s disease. Precautions: Iron preparations by mouth should not be used in patients with diverticulitis or obstruction of the bowel. Use with caution in patients with a delayed intestinal transit time due to some intestinal disorder. Because of the risk of constipation elderly patients should use them with caution – there is a risk of faecal blockage (impaction) of the bowel. The body can become over-loaded with iron (haemosiderosis) if iron preparations are taken when they are not needed, particularly in patients who have disorders of iron storage or absorption from the intestine. Iron preparations should not be given to patients receiving repeated blood transfusions or to treat anaemias that are not due to iron deficiency. Do not use oral iron together with injections of iron. Liquid mixtures containing iron salts should be taken well diluted with water and through a straw to prevent blackening of the teeth. Interactions: Iron reduces the absorption of tetracyclines, ciprofloxacin, norfloxacin, ofloxacin, levodopa, penicillamine and zinc.
|
| Irriclens aerosol |
Irriclens aerosol contains sodium chloride. It is used to irrigate wounds.
|
| isocarboxazid |
isocarboxazid (Marplan) is an MAO inhibitor antidepressant drug. See Chapter 4. Adverse effects and Precautions are similar to those under phenelzine.
|
| isoflurane |
isoflurane (Aerrane) is a volatile general anaesthetic with actions similar to halothane.
|
| isoniazid |
isoniazid (isionicotinic acid hydrazine, INAH, in Rifater, in Rifinah, in Rimactazid) an antibacterial drug used to treat tuberculosis. See Chapter 50. Adverse effects: Isoniazid may cause nausea and vomiting. High daily doses may cause inflammation of nerves (peripheral neuritis), producing numbness, pins and needles and weakness. This may be prevented by giving vitamin B6 (pyridoxine) 10 mg daily. Isoniazid usually lifts the mood but it may also cause mental disturbances which are usually reversed on withdrawal of the drug; it may very rarely cause damage to the nerve of the eye (optic neuritis), convulsions and systemic lupus erythematosis (SLE - a disease of unknown cause with symptoms of fever, muscle and joint pain, blood disorders and skin eruptions). Allergic reactions include fever, skin rashes, swollen glands (lymphadenopathy) and, rarely, blood disorders, liver damage and jaundice (stop immediately if jaundice develops or if signs of liver damage appear – persistent nausea, vomiting and generally feeling unwell). Raised blood sugar and swollen breasts in men (gynaecomastia) have been associated with isoniazid treatment. Withdrawal symptoms may occur on stopping the drug; these include headache, irritability, nervousness, insomnia and excessive dreaming. Precautions: It should not be used in patients with porphyria (a hereditary disorder of metabolism) or a history of liver damage caused by drugs. Do not use in patients suffering from manic or hypomanic psychosis. It should be given with caution to patients suffering from epilepsy, history of serious mental illness, chronic alcoholism or with impaired kidney or liver function. It should be used with caution in pregnancy and breastfeeding mothers. Some patients inactivate it slowly and therefore they may develop adverse effects on smaller doses. Tuberculosis bacteria rapidly become resistant to isoniazid and therefore it should not be used alone. Interactions: Phenytoin, primidone, carbamazepine.
|
| Isophane protamine insulin |
Isophane protamine insulin see Chapter 42.
|
| isoprenaline |
isoprenaline (isoprenaline hydrochloride, isoprenaline sulphate) is a non-selective beta-stimulant used to treat asthma (see Chapter 14). It is also used (as Saventrine injection) to treat disorders of the heart, see Chapter 24. Adverse effects include rapid beating of the heart, chest pain, dry mouth, faintness, dizziness, headache, nervousness, tremor, diarrhoea and weakness. Irregularities of heart rate may occur. Precautions: Isoprenaline should not be used in patients with heart disease, asthma due to heart disease, disorders of heart rhythm or over-active thyroid. It should be used with caution in patients with raised blood pressure or diabetes and in pregnancy. Tolerance may develop to isoprenaline taken in an aerosol; in such cases the dose should not be increased but the drug should be stopped and an alternative drug used. Interactions: MAOIs, sympathomimetic drugs, tricyclic antidepressants.
|
| isopropyl myristate |
isopropyl myristate (in Dermol, in Diprobath, in Emulsiderm, in Hydromol) is resistant to oxidation and water and does not become rancid. It is used in skin applications to make them relatively free from greasiness. It is used as a solvent and is absorbed readily by the skin. It is also used as a food additive.
|
| Isopto Alkaline |
Isopto Alkaline eye drops contain hypromellose, as a lubricant. Do not wear soft contact lenses.
|
| Isopto Carbachol |
Isopto Carbachol eye drops contain carbachol with the lubricant hypromellose. They are used to treat glaucoma. See p. 53. Adverse effects and Precautions: Do not use if the cornea is damaged or in patients with inflammation of the iris in the eye. Do not wear soft contact lenses.
|
| Isopto Plain |
Isopto Plain eye drops contain the lubricant hypromellose.
|
| seborrhoeic dermatitis |
Efalith ointment contains lithium succinate and zinc sulphate. It is used to treat the skin disorder seborrhoeic dermatitis. Lithium has antifungal and anti-inflammatory properties and may also stimulate the immune system. Adverse effects: Local irritation. Precautions: It should not be used in children. Use with caution in psoriasis. It should not be applied to the eyes or mucous membranes (e.g. mouth).
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